Effects of cardiac resynchronization therapy on heart rate variability in patients with chronic systolic heart failure and intraventricular conduction delay

Alonso, Christine; Ritter, Philippe; Leclercq, Christophe; Mabo, Philippe; Bailleul, Christophe; Daubert, Jean‐Claude

doi:10.1016/s0002-9149(03)00171-1

Cited by 23 publications

(14 citation statements)

References 16 publications

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“…Many clinical trials have shown that it can improve cardiac function and symptoms, reduce hospitalization, and prolong life in appropriately selected patients. [14][15][16][17][18][19][20] Although there has been 1 report of the relationship between CRT and renal function, 21 the effects of CRT on renal function in patients with renal insufficiency remain unknown. Because Tables 1,2. the risk of cardiovascular events becomes evident at an estimated GFR <60 ml/min, in the present study we defined eGFR <60 ml/min as renal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Preservation of Renal Function in Response to Cardiac Resynchronization Therapy

Kimura

Ito

Chinushi

et al. 2008

Circ J

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here are strong interactions between cardiovascular and renal diseases. "Cardiorenal syndrome" indicates the presence or development of renal dysfunction in patients with heart failure (HF). 1,2 Although medical therapy, including angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), -blockers, and spironolactone, for HF has advanced significantly during the past decade, the prognosis and quality of life of patients with HF remains poor. [3][4][5][6] Furthermore, it is noteworthy that impaired renal function is associated with poor outcomes among HF patients. 1,2 Thus, therapy addressing the issue of renal protection is important for patients with HF.Cardiac resynchronization therapy (CRT) reduces the symptoms and improves left ventricular (LV) function in appropriately selected HF patients with cardiac dyssynchrony. 7,8 However, whether CRT has beneficial effects on renal function in HF patients, especially those with renal dysfunction, remains unclear. Therefore, the purpose of this study was to investigate the effect of CRT on renal function in patients with HF. Furthermore, we examined whether the use and doses of medical therapy changed before and after CRT therapy. Methods Patient PopulationWe performed a retrospective analysis of 23 consecutive patients with HF who had CRT or CRT-defibrillation (CRTD). Inclusion criteria included QRS duration >130 ms, LV ejection fraction (LVEF) <35%, and New York Heart Association (NYHA) functional class III, despite optimal medical therapy. 7 All patients underwent cardiac catheterization before CRT implantation. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of CRT Device ImplantationCardiologists certified by the Japanese Arrhythmia Society implanted the CRT/CRTD devices. A coronary sinus venogram was obtained, and the LV pacing lead was inserted through the coronary sinus and placed in the lateral or posterolateral vein in all patients. Both atrial and right ventricular leads were implanted in patients with sinus rhythm and only the right ventricular lead was placed in patients with chronic atrial fibrillation (AF). Data AnalysisClinical data for the patients were evaluated at baseline and at the 3-month follow-up: assessment of NYHA func- Background Cardiac resynchronization therapy (CRT) has recently been introduced as a new option for patients with severe heart failure, but its effect on renal function remains unclear. Methods and ResultsTwenty-three patients receiving CRT were studied. Responders were those who showed >0% increase in left ventricular ejection fraction after CRT by echocardiography. Clinical parameters, echocardiographic measurement, renal function, and prescriptions were examined before and 3 months after CRT, and the relationship between the response to CRT and renal function was examined. The responders had a better prognosis than the non-responders (p<0.05). There was a significant difference in the change in the estimated glomerular filtration rate between the responde...

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Section: Discussionmentioning

confidence: 99%

Preservation of Renal Function in Response to Cardiac Resynchronization Therapy

Kimura

Ito

Chinushi

et al. 2008

Circ J

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“…However, previous studies with cross-over design [6,34] and data comparing de novo implantation with device replacement [5] have shown that HRV changes after CRT are a true treatment effect rather than a consequence of the implant procedure. The predictive value of SDANN at the first post-implantation week, suggests that a pre-implantation analysis of HRV might help in the selection of responders to CRT.…”

Section: Limitationsmentioning

confidence: 98%

Heart rate variability monitored by the implanted device predicts response to CRT and long‐term clinical outcome in patients with advanced heart failure

Landolina

Gasparini

Lunati

et al. 2008

European J of Heart Fail

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Background: Few data exist on the long-term changes and the prognostic value of heart rate variability (HRV) assessed by implanted devices in heart failure (HF) patients treated with resynchronization therapy (CRT). Aims: To analyze the long-term changes in the standard deviation of 5-minute median atrial-atrial sensed intervals (SDANN), and assess its role in predicting CRT efficacy and major cardiovascular events. Methods and results: We included 509 consecutive patients implanted with CRT devices. At 12-month follow-up, 44 patients had died and 86 patients had at least one HF hospitalisation. A significant increase in SDANN occurred after 4 weeks of CRT (from 69 ± 22 ms to 82 ± 27 ms, p b 0.001). A further increase in SDANN was observed 6 months after implantation. Multivariable analysis identified SDANN as the sole predictor of major cardiovascular events (p = 0.03) among several baseline parameters. SDANN ≤ 65 ms at the first week and SDANN ≤ 76 ms after 4 weeks of CRT yielded the best prediction of all-cause mortality and urgent heart transplantation on Kaplan-Meier analysis (log-rank test p = 0.015 and p = 0.011, respectively for week 1 and 4 values). Moreover, relative reduction in LVESV after CRT significantly correlated with SDANN at week 1 (r = −0.596, p = 0.012), and week 4 (r = −0.703, p = 0.001). Conclusions: Device-monitored HRV is a useful tool to identify, early after implantation, patients with a low likelihood of long-term benefits from CRT and at high risk for cardiovascular events.

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“…CRT has been shown before to improve sympatho-vagal balance in patients with advanced heart failure [74][75][76]. It is not known whether this improvement is due to changes in circulating plasma catecholamines, central sympatho-vagal tone, or to direct cardiac innervation.…”

Section: Imaging Predictive Factorsmentioning

confidence: 99%

Imaging predictive factors and exercise training in CRT patients

Abreu

Santa-Clara

2016

Monaldi Arch Chest Dis

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Cardiac resynchronization therapy (CRT) is an established treatment for patients with moderate-to-severe chronic heart failure (CHF) and intraventricular conduction delay, which is identified by a QRS interval of 120 msec or more on a 12-lead electrocardiogram (ECG). CRT improves functional capacity, reduced hospitalizations for worsening CHF and increased survival, however, about 30-40% of patients who undergo CRT are non-responders with no clinical or echocardiographic improvement. Imaging parameters for prediction of CRT response have been reviewed. Cardiac magnetic resonance (CMR), recognized as the gold standard to assess viability, has shown to obtain good results regarding quantification of scar burden. CMR-derived measures of mechanical dyssynchrony appear to predict the outcome of CRT, however these have not been externally validated. Nuclear imaging techniques, namely single-photon emission cardiac tomography (SPECT) provide data on scar burden and location, left ventricular (LV) function, LV contraction and mechanical dyssynchrony from a single scan. The presence, location and burden of myocardial scar have been shown to affect response to CRT. However, compared to CMR, the low spatial resolution of scintigraphy might overestimate the scar extent. This problem can be overcome by positron emission tomography (PET). SPECT has also been used to quantify dyssynchrony, using phase analysis. Imaging investigation is ongoing, trying to better identify CRT non-responders. The combination of ExT in CRT has not been well investigated, however some data show that different aerobic exercise modes and intensities can further improve CRT benefits. Data available on the effects of ExT in patients with CRT have been reviewed.

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Effects of cardiac resynchronization therapy on heart rate variability in patients with chronic systolic heart failure and intraventricular conduction delay

Cited by 23 publications

References 16 publications

Preservation of Renal Function in Response to Cardiac Resynchronization Therapy

Preservation of Renal Function in Response to Cardiac Resynchronization Therapy

Heart rate variability monitored by the implanted device predicts response to CRT and long‐term clinical outcome in patients with advanced heart failure

Imaging predictive factors and exercise training in CRT patients

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