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Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure

Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure

Published on: October 1, 2019

The effect of cardiac resynchronization therapy on functional capacity based on cardiopulmonary exercise testing: a

Jhiamluka Solano¹, Nithusa Rahunathan², Dominic L Sykes²

¹Northern Lincolnshire and Goole NHS Trust, Scunthorpe General Hospital, Scunthorpe DN15 7BH, UK.

European Heart Journal Open

|January 26, 2026

Insights

Cardiac resynchronization therapy (CRT) significantly improves exercise capacity and ventilatory efficiency in heart failure patients. Cardiopulmonary exercise testing (CPET) can guide personalized management and identify those needing further intervention.

Area of Science:

Cardiology
Exercise Physiology
Medical Technology

Background:

Cardiac resynchronization therapy (CRT) is indicated for heart failure with reduced ejection fraction (HFrEF) and conduction delay.
Post-CRT management strategies are not well-established.
Cardiopulmonary exercise testing (CPET) offers objective functional assessment for CRT response and device optimization.

Purpose of the Study:

To systematically review and meta-analyze the impact of CRT on key CPET parameters.
To identify patients who might benefit from additional interventions post-CRT.

Main Methods:

Systematic search of MEDLINE, EMBASE, and Cochrane Central databases up to May 2024.
Inclusion of randomized controlled trials, non-randomized trials, and cohort studies evaluating CPET changes post-CRT.
Primary outcome: peak VO₂; Secondary outcomes: anaerobic threshold and ventilatory efficiency.

Main Results:

Fourteen studies (858 patients) were analyzed.
CRT significantly improved peak VO₂ (SMD = 0.62), anaerobic threshold (SMD = 0.70), and ventilatory efficiency (SMD = -0.45).
Significant heterogeneity was observed, potentially due to variations in protocols and patient characteristics.

Conclusions:

CRT enhances exercise capacity and ventilatory efficiency, demonstrating physiological benefits.
CPET can personalize post-CRT care, including device programming and rehabilitation.
Deteriorating CPET parameters may signal advanced heart failure, prompting timely care planning.

Read full analysis

Abstract

Aims:

Cardiac resynchronization therapy (CRT) has a class 1a indication for patients with heart failure due to reduced ejection fraction (HFrEF) who also have conduction delay. Post-CRT management pathways are uncommon. Cardiopulmonary exercise testing (CPET) provides objective functional assessments and may serve as a valuable tool in assessing CRT response and guide device optimization. This systematic review and meta-analysis aimed to assess the effect of CRT on key CPET parameters and identify patients who may benefit from further intervention.

Methods And Results:

A systematic search of MEDLINE, EMBASE, and Cochrane Central (May 2024) identified randomized controlled trials, non-randomized trials, and cohort studies evaluating changes in CPET post-CRT. Primary outcome was peak VO₂, with anaerobic threshold and ventilatory efficiency as secondary outcomes. Results were reported as standardized mean differences (SMD) and effect sizes using Cohen's d.

Results:

Fourteen studies (12 cohort studies and 2 RCTs) involving 858 patients were included. CRT was associated with significant improvements in peak VO₂ (SMD = 0.62, 95% CI 0.19-1.05, P < 0.001), anaerobic threshold (SMD = 0.70, 95% CI 0.03-1.36, P = 0.04), and ventilatory efficiency (SMD = -0.45, 95% CI -0.68 to -0.21, P < 0.001). Considerable heterogeneity was noted, likely reflecting differences in exercise protocols, patient characteristics, and device programming.

Conclusion:

CRT improves exercise capacity and ventilatory efficiency, reinforcing its physiological benefits beyond cardiac remodelling. CPET may support personalized post-CRT care, including optimization of device programming, medications, and rehabilitation. Worsening CPET parameters may help identify patients progressing to advanced heart failure, allowing for timely care planning.

Keywords:

Anaerobic threshold Cardiac resynchronization therapy Cardiopulmonary exercise testing Heart failure Peak oxygen uptake Ventilatory efficiency

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