Endothelial Function Predicts New Hospitalization due to Heart Failure Following Cardiac Resynchronization Therapy
Kunio Yufu1, Tetsuji Shinohara1, Yuki Ebata1
1From the Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
Insights
Peripheral endothelial function, assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT), predicts long-term outcomes in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT). Improved endothelial function correlates with better coronary microcirculation.
Area of Science:
- Cardiology
- Heart Failure Research
- Vascular Function
Background:
- Cardiac resynchronization therapy (CRT) is an established treatment for chronic heart failure (HF).
- The study investigates the association between peripheral endothelial function and long-term CRT outcomes.
- The linkage between endothelial function and coronary flow reserve (CFR) was also explored.
Purpose of the Study:
- To determine if peripheral endothelial function assessment predicts long-term outcomes in CRT patients.
- To investigate the relationship between endothelial function and coronary flow reserve (CFR) post-CRT.
- To identify predictors of hospitalization due to HF progression in CRT recipients.
Main Methods:
- 34 advanced HF patients undergoing CRT were evaluated pre-CRT and 6-8 months post-CRT.
- Peripheral endothelial function was measured using reactive hyperemia peripheral arterial tonometry (RH-PAT).
- Coronary flow reserve (CFR) was assessed via transthoracic echocardiography in 24 patients.
Main Results:
- A depressed RH-PAT index (RHI ≤1.5) was associated with a higher incidence of hospitalization for HF progression (log-rank 5.40).
- Baseline RHI and log brain natriuretic peptide independently predicted HF progression hospitalization.
- Baseline RHI positively correlated with the change in CFR at 6-8 months (R = 0.434, P = 0.0343).
Conclusions:
- Baseline peripheral endothelial function is a significant predictor of long-term CRT outcomes.
- Improved coronary microcirculation may be linked to better baseline endothelial function in these patients.
- RH-PAT assessment offers valuable prognostic information for HF patients treated with CRT.
Background:
Cardiac resynchronization therapy (CRT) has been established as a treatment for patients with chronic heart failure (HF). We tested the hypothesis that assessment of peripheral endothelial function is associated with the long-term outcome of CRT and its linkage to coronary flow reserve (CFR) was also investigated.
Methods:
From 2010, a total of 34 consecutive patients implanted with CRT for the treatment of advanced HF were evaluated at baseline (immediately before CRT) and 6-8 months after CRT. Endothelial function was evaluated by measurement of reactive hyperemia peripheral arterial tonometry (RH-PAT). In 24 of 34 patients, CFR was determined by transthoracic echocardiography.
Results:
Based on the receiver-operating characteristic curves, depressed RH-PAT index (RHI) was defined as ≤1.5. Accurate follow-up information during the mean of 343 ± 120 days was obtained in 20 preserved RHI group (mean age 66 ± 1.8 years) and 14 depressed RHI group (71 ± 2.2 years). Kaplan-Meier survival analysis demonstrated that depressed RHI group had higher prevalence of new hospitalization due to HF progression (log-rank 5.40). Cox proportional hazards regression analysis revealed that the baseline log brain natriuretic peptide (hazard ratio 5.95) and the baseline RHI value (hazard ratio 0.066) were independently associated with the incidence of new hospitalization due to HF progression. The baseline RHI values were positively correlated with the 6-8 months change of CFR (R = 0.434, P = 0.0343).
Conclusions:
Our results suggest that the baseline peripheral endothelial function could predict the long-term outcome of CRT. The results also suggest that improvement of coronary microcirculation might be associated with the better baseline endothelial function.
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