The effect of cardiac resynchronization therapy on arterial stiffness and central hemodynamic parameters

Abstract

Introduction: Cardiac resynchronization therapy (CRT) is a device-based method of treatment which decreases morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). This study was aimed to investigate the effects of CRT on hemodynamic and arterial stiffness parameters evaluated by noninvasive method, and determine whether there is a correlation between the changes after CRT in these parameters and the clinical response to CRT or not. Methods:The study included 46 patients with HFrEF who were planned to undergo CRT implantation. Before the CRT implantation, clinical and demographic data were recorded from all patients. Hemodynamic and arterial stiffness parameters were measured oscillometrically by an arteriograph before CRT implantation. The patients were re-evaluated minimum three months after CRT; the above-mentioned parameters were measured again and compared to the pre-CRT period.Results: Compared to the period before CRT, mean systolic blood pressure (SBP) (116.8 ± 19.1 mm Hg vs 127.7 ± 20.9 mm Hg, P = .005), central SBP (cSBP) (106.2 ± 17.3 mm Hg vs 116.8 ± 18.7 mm Hg, P = .015), cardiac output (CO) (4.6 ± 0.8 lt/min vs 5.1 ± 0.8 lt/min, P = .002), stroke volume (65.6 ± 16.3 mL vs 72.0 ± 14.9 mL), and pulse wave velocity (PWV) (10 ± 1.6 m/sec vs 10.4 ± 1.8 m/sec, P = .004) increased significantly in post-CRT period. In addition, the same parameters were significantly increased post-CRT period in patients with clinical response. However, there was not any similar increase in nonresponder patients. Conclusion:This study demonstrated that SBP, CO, and PWV increased significantly after CRT. The modest increases in these parameters were observed to be associated with positive clinical outcomes. K E Y W O R D S cardiac response, cardiac resynchronization therapy, congestive heart failure, hemodynamics parameters, pulse wave velocity | 499 COKSEVIM Et al.

The Association Between On-treatment Ambulatory Central Blood Pressure and Left Ventricular Reverse Remodeling in Heart Failure With Reduced Ejection Fraction

“…Similarly, one study showed that BBP and CBP increased in patients with a clinical response after cardiac resynchronization therapy, but there was no increase in non-responder patients. 28) To find out the relationship between LVEF and on-treatment SBP, we further analyzed the association between follow-up LVEF and on-treatment SBP and there was a significant interaction (data not shown). In other words, higher LVEF was related to higher on-treatment SBP.…”

The Analysis of Arterial Stiffness in Heart Failure Patients: The Prognostic Role of Pulse Wave Velocity, Augmentation Index and Stiffness Index

“…On the other hand, in HF patients with reduced systolic function, a lower aPWV may reflect the severity of loss of ventricular function rather than aortic stiffness [ 18 ]. This relation can be demonstrated by the observed modest increases in SBP, CO, and aPWV in HFrEF patients after the implantation of CRT, very often associated with favourable clinical outcomes [ 29 ]. However, results on the correlation between parameters obtained by the measurement of arterial stiffness and wave reflection and survival in HFrEF patients are currently inconclusive [ 14 , 30 , 31 ].…”

Endothelial, Vascular and Sympathetic Alterations as Therapeutic Targets in Chronic Heart Failure

“…Cardiac resynchronization therapy in heart failure exerts not only an improvement in the clinical symptoms and cardiac haemodynamics but also a decrease in arterial stiffness and a concomitant reduction in sympathetic cardiovascular drive [ 6 , 54 ]. Over the years, other device-based interventions have been promoted in CHF.…”