Maximum derivative of left ventricular pressure predicts cardiac mortality after cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) has been reported to improve cardiac performance. However, CRT in patients with advanced heart failure is not always accompanied by an improvement in survival rates. We investigated the association between hemodynamic studies and long-term prognosis after CRT.
METHODS: A total of 68 consecutive patients receiving CRT devices due to advanced heart failure were assessed by hemodynamic study and long-term outcome after implantation of the device. Hemodynamic parameters were measured both with the CRT on and off.
RESULTS: Patients demonstrated significant improvement in the maximum first derivative of left ventricular (LV) pressure (LV dP/dt(max) ) and QRS duration after periods with the CRT on. During the follow-up period of 34.9 ± 17.6 months, basal LV dP/dt(max) and isovolemic LV pressure half-time (T½), but not percent change in LV dP/dt(max) , were independent predictors of cardiac mortality or hospitalization due to heart failure after multivariate Cox regression analysis. The Kaplan-Meier survival analysis revealed that patients in the lowest basal LV dP/dt(max) tertile or the longest basal T½ tertile exhibited a significantly higher cardiac-caused mortality or heart failure hospitalization.
CONCLUSIONS: Lower LV dP/dt(max) or longer T½ independently predicts cardiac mortality or heart failure hospitalization in patients receiving CRT. The assessment of the basal LV dP/dt(max) and T½ could provide useful information in long-term prognosis after CRT.