Prognostic Value Of Pulmonary Vascular Resistance For Ventricular Arrhythmia Events In Patients With Left Heart Failure After Implantable Cardioverter Defibrillator Recipients

[Objectives]:The purpose of this study was to investigate the value of pulmonary vascular resistance(PVR)on predicting the occurrence of ventricular tachycardia(VT)and the heart failure re-hospitalization or all-cause mortality in ICD patients with left heart failure[Methods]122 left heart failure patients were enrolled who received ICDs or CRT-Ds for primary prevention or secondary prevention.All patients underwent ultrasound Doppler examination by recording pulmonary artery systolic pressure(PASP),pulmonary artery mean pressure(mPAP)and pulmonary vascular resistance(PVR)before implantation.The program-controlled data and end point events were recorded during follow-up.The primary end point was defined as receiving ICD appropriate treatment(ATP or Shock)for malignant ventricular arrhythmia,and the secondary end point was defined as the composite of re-hospitalization or all-cause mortality.[Results]During 4.2 years follow-up,121 episodes of ventricular tachycardia or ventricular fibrillation were terminated by appropriate ICD therapy in 36(29.5%)patients.Appropriate ICD therapy consisted of 72 episodes of ATP in 32(26.3%)patients and 39 ICD shocks in 16(13.1%)patients.Univariate Cox analysis found that ICD indication(secondary vs.primary prevention),PASP and PVR were significantly associated with appropriate ICD therapy.Multivariate Cox analysis demonstrated that PVR(HR:1.63 95%CI:1.17-2.01,P<0.01)was the independent predictor for appropriate ICD therapy in heart failure patients.When PVR=2.52 WUs was taken as the optimal cut-off point,Youden index was the highest,and the sensitivity and specificity of predicting patients with ventricular tachycardia and receiving appropriate ICD treatment were 61.1%and 79.1%respectively.Kaplan-Meier cumulative risk curve indicated that patients with PVR≥2.5WUs were more likely to have ventricular tachycardia and receive appropriate ICD treatment than patients with PVR<2.5WUs(Log Rank test,P =0.002).The secondary composite end point was documented in 31 patients.In total,31 episodes of heart failure re-hospitalizations in 29(23.7%)patients,and 18(14.7%)patients died.Multivariable Cox analysis showed that PVR(HR:2.03,95%CI:1.21-3.12,P<0.01)was the only independent predictor of the secondary composite end point for heart failure patients.When PVR=2.54 WUs was taken as the optimal cut-off point,Youden index was the largest,and the sensitivity and specificity of predicting secondary endpoint events were 69.7%and 87.6%respectively.Kaplan-Meier cumulative risk curve indicated that patients with PVR ≥2.5WUs were more likely to have clinical composite endpoint events due to heart failure rehospitalization or all-cause death after surgery than patients with PVR<2.5WUs(Log Rank test,P<0.05).[Conclusions]The elevation of PVR predicts ventricular tachycardia causing appropriate ICD therapy as well as the composite of left heart failure re-hospitalization or all-cause mortality to patients of left heart failure with ICDs.