Time Course of Effects of Cardiac Resynchronization Therapy in Chronic Heart Failure: Benefits in Patients with Preserved Exercise Capacity

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

doi:10.1111/j.1540-8159.2008.01073.x

Cited by 31 publications

(18 citation statements)

References 44 publications

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“…In our study, V̇ E /V̇CO 2 significantly decreased post-CRT as has been previously reported (13–15). However, the contributions of the components of the alveolar gas equation to the observed decline of V̇ E /V̇CO 2 have not been previously shown.…”

Section: Discussionsupporting

confidence: 91%

Modulation of Ventilatory Reflex Control by Cardiac Resynchronization Therapy

Čundrle

Johnson

Rea

et al. 2015

Journal of Cardiac Failure

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Background Heart failure (HF) is characterized by heightened sensitivity of the CO2 chemoreflex and the ergoreflex which promote increased ventilatory drive manifest as increased minute ventilation per volume of expired CO2 (VE/VCO2). The aims of this study were to evaluate the effects of cardiac resynchronization therapy (CRT) on carbon dioxide (CO2) chemosensitivity and the arterial CO2 setpoint. Methods and results Consecutive HF patients (n=35) who underwent clinically-indicated CRT were investigated by cardiopulmonary exercise testing and CO2 chemosensitivity by a rebreathe method before and 4-6 months post-CRT. Pre- and post-CRT measures were compared by either paired t-test or Wilcoxon test. Decreased peak VE/VCO2 (44±10 vs. 40±8; p<0.01), CO2 chemosensitivity (2.2±1.1 vs. 1.7±0.8 L/min/mmHg; p=0.04) and increased peak end-tidal CO2 (29±5 vs. 31±5 mmHg; p<0.01) were also observed post-CRT. Multivariate analysis adjusted for age and gender showed the decrease of peak VE/VCO2 from pre- to post-CRT was most strongly associated with the increase of peak end-tidal CO2 (b=-0.84; F=21.5; p<0.0001). Conclusion Decrease of VE/VCO2 post-CRT is associated with decreased CO2 chemosensitivity and increase of the arterial CO2 setpoint consistent with decreased activation of both the CO2 chemoreflex and the ergoreflex.

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Section: Discussionsupporting

confidence: 91%

Modulation of Ventilatory Reflex Control by Cardiac Resynchronization Therapy

Čundrle

Johnson

Rea

et al. 2015

Journal of Cardiac Failure

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“…As we did not know the initial HRV and HRT parameters in CRT patients, we assumed that they had been improved with functional status. This assumption was strongly supported with the previous studies (13)(14)(15)(16) showing improved HRV and HRT parameters in CRT responders. Similarly, an improvement might be achieved in ICD patients with a placebo effect.…”

Section: Study Limitationssupporting

confidence: 80%

“…In studies, which investigated HRV and HRT parameters in CRT patients, improvement of functional capacity was accompanied with the improvement of HRV and HRT parameters in good responders to CRT (13)(14)(15)(16). However, we do not know whether there is an additional benefit of CRT on autonomic functions independent from the improvement in functional capacity.…”

Section: Introductionmentioning

confidence: 89%

The effects of cardiac resynchronization treatment on autonomic functions aside from functional status in heart failure

Arslan¹,

Balcı²,

Kocaoğlu³

et al. 2013

Anadolu Kardiyol Derg

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Objective: Cardiac resynchronization therapy (CRT) improves heart rate variability (HRV) and heart rate turbulence (HRT) parameters. Herein, our aim was to compare these parameters with intracardiac-cardioverter defibrillator (ICD) patients with similar functional status to detect possible additional benefits of CRT on autonomic functions. Methods: Patients who had systolic HF (NYHA class II and III) with an ejection fraction <35% were enrolled in this observational, cross-sectional study. These patients were implanted either an ICD or a CRT device. A 24-hour Holter recording was obtained to assess HRV and HRT parameters in 2 groups. Unpaired t-test and Chi-square test were used for comparisons between 2 groups. Logistic regression analysis was performed to determine the variables affecting functional status. Results: Of 105 patients included in the study; 55 had CRT and 50 had ICD device. The baseline characteristics of the patients were similar in both groups. SDNN, SDANN, SDNN index, and LFnu were similar in both groups; however, RMSSD, pNN50, HFnu, LF/HF ratio, turbulence slope and albeit to a non-significant value turbulence onset were better in CRT group. When the HRV and HRT parameters were compared according to functional status, patients in functional class II had significantly better HRV and HRT parameters when compared to the ones in class III (p<0.05 for all). Regression analysis showed that only SDNN was associated with functional class [OR: 0.89 (95% CI: 0.80-0.98), p=0.03]. After the covariance analysis to eliminate the effects of functional status on HRV and HRT parameters; the parameters mostly related with the parasympathetic system activity, namely RMSSD, pNN50, HFnu, LF/HF ratio, turbulence onset and turbulence slope were still better in CRT group. Conclusion: The most striking finding in our study is that HRV and HRT values related with parasympathetic activation are better in CRT patients when compared to ICD patients with similar functional status. Therefore, upgrading to CRT may have additional benefits on autonomic functions, which needs further investigation. (Anadolu Kardiyol Derg 2013; 13: 439-45) Key words: Heart failure, heart rate variability, heart rate turbulence, cardiac resynchronization therapy, functional status, regression analysis Original Investigation Özgün Araşt›rma 439ÖZET Amaç: Kardiyak resenkronizasyon tedavisinin (KRT) kalp yetersizliği (KY) hastalarında kalp hızı değişkenliği (KHD) ve kalp hızı türbülansını (KHT) düzeltti-ği bilinmektedir. Bu çalışmada amacımız KRT'nin fonksiyonel kapasiteyi düzelterek oluşturduğu KHD ve KHT düzelmesinin üzerine olası ek faydasını incelemektir. Bu amaçla intrakardiyak kardioverter defibrilatörü (İKD) olan KY hastalarındaki KHD ve KHT parametrelerini KRT'li hastalarla karşılaştırdık.Yöntemler: Ejeksiyon fraksiyonu <%35 olan sistolik kalp yetmezlikli (NYHA sınıf 2-3) hastalar bu gözlemsel ve kesitsel çalışmaya dahil edildi. Bu hastalara İKD veya KRT cihazı implante edilmişti. Yirmi dört saatlik Holter EKG kayıtlarından KHD ve ...

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“…Several studies have provided further insights into the clinical role of BRS in heart failure by showing that cardiac resynchronisation therapy (CRT), through its mechanical and haemodynamic effects on the left ventricle, is able to reduce cardiac sympathetic afferent activity thus improving BRS [16,17]. Furthermore, in a group of 32 patients studied 1 day after implantation and with the CRT device either on or off, CRT acutely increased BRS.…”

Section: Clinical Valuementioning

confidence: 99%

Clinical value of baroreflex sensitivity

et al. 2012

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The arterial baroreflex is an important determinant of the neural regulation of the cardiovascular system. It has been recognised that baroreflex-mediated sympathoexcitation contributes to the development and progression of many cardiovascular disorders. Accordingly, the quantitative estimation of the arterial baroreceptor-heart rate reflex (baroreflex sensitivity, BRS), has been regarded as a synthetic index of neural regulation at the sinus atrial node. The evaluation of BRS has been shown to provide clinical and prognostic information in a variety of cardiovascular diseases, including myocardial infarction and heart failure that are reviewed in the present article.

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Time Course of Effects of Cardiac Resynchronization Therapy in Chronic Heart Failure: Benefits in Patients with Preserved Exercise Capacity

Abstract: Improvement in functional status is associated with restoration of neurohormonal reflex control at medium term. Less depressed functional status (peak VO(2)) was the strongest predictor of responders to CRT.

Cited by 31 publications

References 44 publications

Modulation of Ventilatory Reflex Control by Cardiac Resynchronization Therapy

Modulation of Ventilatory Reflex Control by Cardiac Resynchronization Therapy

The effects of cardiac resynchronization treatment on autonomic functions aside from functional status in heart failure

Clinical value of baroreflex sensitivity

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