Time course of effects of cardiac resynchronization therapy in chronic heart failure

Benefits in patients with preserved exercise capacity

Massimo F. Piepoli, Giovanni Q. Villani, Ugo Corrà, Daniela Aschieri, Guido Rusticali

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives: To assess in patients with chronic heart failure the effect of cardiac resynchronization therapy (CRT) over 12 months' follow-up the time course of the changes in functional and neurohormonal indices and to identify responders to CRT. Methods: Eighty-nine patients (74.1 ± 1 years, left ventricular ejection fraction [LVEF] <35%), QRS complex duration >150 ms, in stable New York Heart Association (NYHA) class III or IV on optimal medical treatment were prospectively randomized either in a control (n = 45) or CRT (n = 44) group and underwent clinical evaluation, cardiopulmonary exercise testing (CPET), 2D-Echo, heart rate variability (HRV), carotid baroreflex (BRS), and BNP assessments before and at 6- and 12-month follow-up. Results: In the CRT group, improvement of cardiac indices and BNP concentration were evident at medium term (over 6 months) follow-up, and these changes persisted on a longer term (12 months) (all P <0.05). Instead CPET indices and NYHA class improved after 12 months associated with restoration of HRV and BRS (all P <0.05). We identified 26 responders to CRT according to changes in LVEF and diameters. Responders presented less depressed hemodynamic (LVEF 25 ± 1.0 vs 22 ± 0.1%), functional (peak VO2 10.2 ± 0.2 vs 6.9 ± 0.3 ml/kg/min), and neurohormonal indices (HRV 203.6 ± 15.7 vs 147.6 ± 10.ms, BRS 4.9 ± 0.2 vs 3.6 ± 0.3 ms/mmHg) (all P <0.05). In the multivariate analysis, peak VO2 was the strongest predictor of responders. Conclusions: Improvement in functional status is associated with restoration of neurohormonal reflex control at medium term. Less depressed functional status (peak VO2) was the strongest predictor of responders to CRT.

Original languageEnglish
Pages (from-to)701-708
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume31
Issue number6
DOIs
Publication statusPublished - Jun 2008

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Cardiac Resynchronization Therapy
Heart Failure
Exercise
Stroke Volume
Heart Rate
Baroreflex
Reflex
Multivariate Analysis
Hemodynamics

Keywords

  • Autonomic control
  • Exercise tolerance
  • Heart failure
  • Pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Time course of effects of cardiac resynchronization therapy in chronic heart failure : Benefits in patients with preserved exercise capacity. / Piepoli, Massimo F.; Villani, Giovanni Q.; Corrà, Ugo; Aschieri, Daniela; Rusticali, Guido.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 31, No. 6, 06.2008, p. 701-708.

Research output: Contribution to journalArticle

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abstract = "Objectives: To assess in patients with chronic heart failure the effect of cardiac resynchronization therapy (CRT) over 12 months' follow-up the time course of the changes in functional and neurohormonal indices and to identify responders to CRT. Methods: Eighty-nine patients (74.1 ± 1 years, left ventricular ejection fraction [LVEF] <35{\%}), QRS complex duration >150 ms, in stable New York Heart Association (NYHA) class III or IV on optimal medical treatment were prospectively randomized either in a control (n = 45) or CRT (n = 44) group and underwent clinical evaluation, cardiopulmonary exercise testing (CPET), 2D-Echo, heart rate variability (HRV), carotid baroreflex (BRS), and BNP assessments before and at 6- and 12-month follow-up. Results: In the CRT group, improvement of cardiac indices and BNP concentration were evident at medium term (over 6 months) follow-up, and these changes persisted on a longer term (12 months) (all P <0.05). Instead CPET indices and NYHA class improved after 12 months associated with restoration of HRV and BRS (all P <0.05). We identified 26 responders to CRT according to changes in LVEF and diameters. Responders presented less depressed hemodynamic (LVEF 25 ± 1.0 vs 22 ± 0.1{\%}), functional (peak VO2 10.2 ± 0.2 vs 6.9 ± 0.3 ml/kg/min), and neurohormonal indices (HRV 203.6 ± 15.7 vs 147.6 ± 10.ms, BRS 4.9 ± 0.2 vs 3.6 ± 0.3 ms/mmHg) (all P <0.05). In the multivariate analysis, peak VO2 was the strongest predictor of responders. Conclusions: Improvement in functional status is associated with restoration of neurohormonal reflex control at medium term. Less depressed functional status (peak VO2) was the strongest predictor of responders to CRT.",
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