Document Detail

Early and late effects of cardiac resynchronization therapy on force-frequency relation and contractility regulating gene expression in heart failure patients.
MedLine Citation:
PMID:  18082469     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Heart failure is associated with a reduction in left ventricular (LV) contractility as evidenced by a blunted force-frequency response (FFR) and downregulation of contractility regulating genes. OBJECTIVE: This study sought to investigate whether cardiac resynchronization therapy (CRT) is capable of reversing the blunted FFR and the downregulation of contractility regulating genes. METHODS: Twenty heart failure patients underwent echocardiographic examination during incremental AAI and DDD-CRT pacing at 70, 90, and 110 beats/min, immediately after and 4 months after CRT implantation. The FFR was determined from the ratio of the LV systolic pressure/end systolic volume index at given heart rate. In a subgroup of 6 patients with idiopathic dilated cardiomyopathy, serial LV dP/dtmax was invasively measured during both pacing modes and serial LV endomyocardial biopsies were taken to measure sarcoplasmatic reticulum calcium ATPase 2alpha (SERCA2alpha), phospholamban (PLN), sarcolemmal sodium calcium exchanger (NCX), beta1-adrenoreceptor (beta1-AR), and apelin (APL) gene expression using reverse-transcriptase polymerase chain reaction. RESULTS: Acutely, DDD-CRT pacing was associated with a decrease in dyssynchrony (P <.01) and increase in diastolic filling time (P <.01) at all heart rates paralleled by an upward shift of the FFR (P <.01) without force-frequency amplification. A greater upward shift of the FFR was noticed during DDD-CRT as compared with AAI (P <.01) after 4 months. In addition, CRT was associated with a significant force-frequency amplification at follow-up as evidenced from the steeper slope of the FFR relationship (P = .039). This was associated with a significant upregulation of SERCA2alpha P = .01), PLN (P = .01), their ratio (P = .01), ratio of SERCA/NCX (P = .02), beta1-AR (P = .03), and APL (P = .01) mRNA levels. CONCLUSION: CRT is associated with an acute upward shift in the FFR without force-frequency amplification related to restored synchronicity and increased filling time of the LV. Only chronic CRT is associated with force-frequency amplification in parallel to upregulation of contractility regulating genes.
Wilfried Mullens; Jozef Bartunek; W H Wilson Tang; Leen Delrue; Lieven Herbots; Rik Willems; Bernard De Bruyne; Marc Goethals; Sofie Verstreken; Marc Vanderheyden
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Publication Detail:
Type:  Journal Article     Date:  2007-09-19
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  5     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-08     Completed Date:  2008-05-07     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  52-9     Citation Subset:  IM    
Cardiovascular Center, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium.
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MeSH Terms
Cardiac Pacing, Artificial*
Gene Expression*
Health Status Indicators
Heart Failure / genetics,  therapy*,  ultrasonography
Heart Ventricles / innervation,  physiopathology*
Myocardial Contraction / genetics*
Prospective Studies
Reverse Transcriptase Polymerase Chain Reaction
Stroke Volume
Time Factors
Comment In:
Heart Rhythm. 2008 Jan;5(1):60-1   [PMID:  18065281 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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