Measures of endothelial dysfunction predict response to cardiac resynchronisation therapy

Abstract

ObjectivesCardiac resynchronisation therapy (CRT) improves morbidity and mortality in heart failure (HF). Impaired endothelial function, as measured by flow-mediated dilation (FMD) is associated with increased morbidity and mortality in HF and may help to differentiate responders from non-responders.Methods19 patients were recruited, comprising 94% men, mean age 69±8 years, New York Heart Association functional classes II–IV, QRSd 161±21 ms and mean left ventricular ejection fraction 26±8%. Markers of response and FMD were measured at baseline, 6 and 12 months following CRT.Results14 patients were responders to CRT. Responders had significant improvements in VO2 (12.6±1.7 to 14.7±1.5 mL/kg/min, p<0.05), quality of life score (44.4±22.9–24.1±21.3, p<0.01), left ventricular end diastolic volume (201.5±72.5 mL–121.3±72.0 mL, p<0.01) and 6-min walk distance (374.0±112.8 m at baseline to 418.1±105.3 m, p<0.05). Baseline FMD in responders was 2.9±1.9% and 7.4±3.73% in non-responders (p<0.05).ConclusionsResponse to CRT at 6 and 12 months is predicted by baseline FMD. This study confirms that FMD identifies responders to CRT, due to endothelium-dependent mechanisms alone.

Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

“…found that in a CRT cohort, significant improvement in FMD occurred in both responders and non‐responders at 3, 6, and 12 months although with somewhat greater improvement in the responder group than in the non‐responder group, with these results being only of borderline statistical significance. A recent study by Warriner et al 9. also found that lower FMD predicts response to CRT at 12 months.…”

“…In a subsequent study of 57 patients, Santini et al 8 found that in a CRT cohort, significant improvement in FMD occurred in both responders and non-responders at 3, 6, and 12 months although with somewhat greater improvement in the responder group than in the non-responder group, with these results being only of borderline statistical significance. A recent study by Warriner et al 9 also found that lower FMD predicts response to CRT at 12 months. However, in their cohort, CRT did not result in significant improvement in FMD in either the responder group or the non-responder group.…”

“…Two small studies have shown consistent improvement in microvascular cutaneous reactive hyperaemia post‐CRT insertion,5, 6 while studies of the effects of CRT on large conduit vessels utilizing flow‐mediated [i.e. nitric oxide (NO)‐dependent] dilatation (FMD) have shown conflicting results 7, 8, 9. In this present study, we sought to evaluate the effect of CRT on peripheral vascular function and associated markers of inflammation, as well as vascular and platelet NO signalling, we also examined the effects of CRT on parameters of inflammatory and neurohumoral activation.…”

“…nitric oxide (NO)-dependent] dilatation (FMD) have shown conflicting results. [7][8][9] In this present study, we sought to evaluate the effect of CRT on peripheral vascular function and associated markers of inflammation, as well as vascular and platelet NO signalling, we also examined the effects of CRT on parameters of inflammatory and neurohumoral activation.…”

Efecto de la terapia de resincronización ventricular en los parámetros de disfunción endotelial y función sistólica izquierda en pacientes con insuficiencia cardíaca crónica y bloqueo completo de rama izquierda

“…Un trabajo reciente plantea que los niveles basales de DE mediante método de flujo de arteria braquial podrían utilizarse para predecir respuesta 6-12 meses post-TRV, basado sólo en los mecanismos dependientes del endotelio. Esos autores contaban con 14 respondedores y 5 no respondedores 35 . Además, los marcadores de DE pudieran ser utilizados como marcadores de la ICC con FEVI conservada, una nueva entidad de complejo manejo, lo cual fue planteado también con método de arteria braquial 36 .…”