| Summary: | Objective To evaluate the impact of baseline pulmonary artery systolic pressure (PASP) on cardiac function, left ventricle reverse remodeling and clinical outcomes in patients receiving cardiac resynchronization therapy (CRT). Methods A total of 73 patients undergoing CRT in our hospital between June, 2014 and December, 2017 were enrolled in this retrospective analysis. According to baseline PASP estimated by echocardiography, the patients were divided into pulmonary artery hypertension (PAH) group (PASP≥ 50 mmHg; n=27) and non-pulmonary artery hypertension (NPAH) group (PASP < 50 mmHg; n=46) for comparison of cardiac function, electrocardiogram and echocardiogram at 6 months after CRT. A receiver operator characteristic (ROC) curve was used to evaluate the value of baseline PASP in predicting super-response to CRT. The combined endpoints including all-cause mortality and rehospitalization for heart failure were compared between the 2 groups using Kaplan-Meier analysis. Cox regression models were constructed to analyze the risk factors for long-term prognosis of the patients. Results The 73 patients enrolled included 52 male and 21 female patients at a mean age of 60.32±9.78 years. At 6 months after the operation, the patients in PAH group had significantly poorer improvements in cardiac functions, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) than those in NPAH group (P < 0.05), and showed no obvious improvement in LVEDD (P > 0.05). ROC curve analysis showed that PASP ≤35 mmHg was capable of predicting super-response to CRT with an area under the ROC curve of 0.709 (95%CI: 0.575-0.843, P < 0.05). The patients in PAH group had a higher incidence of combined endpoints than those in NPAH group. PAH (HR=3.64, 95%CI: 1.25-10.61, P < 0.05) and left atrial diameter (HR=1.10, 95%CI: 1.01-1.20, P < 0.05) were independent predictors for the clinical outcomes of the patients. Conclusion Patients with elevated baseline PASP have poorer improvements in cardiac function, left ventricle reverse remodeling and prognosis following CRT than those with normal PASP. A baseline PASP ≤35 mmHg is predictive of super-response to CRT, and PAH and left atrial diameter are independent predictors of the clinical outcomes following CRT.
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