| Rate response and cardiac resynchronisation therapy in chronic heart failure: higher cardiac output does not acutely improve exercise performance: a pilot trial. | |
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MedLine Citation:
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PMID: 18391648 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Rate adaptive pacing (RAP) during cardiac resynchronisation therapy (CRT) in patients with chronic heart failure (CHF) might improve exercise capacity through enhanced cardiac output (CO). Conversely, higher heart rates (HR) might set off a blunted force-frequency response (FFR). METHODS: Fourteen CRT-treated patients (62+/-3 years, left ventricular ejection fraction 30.8+/-2.7%) underwent two cardiopulmonary exercise tests (CPET). CPET1: rate response off; CPET2: rate response on. Conventional and tissue doppler echocardiography were obtained at rest and at peak exercise. RESULTS: Peak values for HR (106+/-5 vs. 127+/-3 bpm; P=0.001) and CO (6.4+/-0.4 vs. 7.4+/-0.4 l/min/m; P=0.001) increased significantly comparing CPET1 and CPET2. Stroke volume index (28.8+/-1.4 vs. 27.9+/-1.2 ml/m, P=0.2) and peak oxygen consumption (17.8+/-0.9 vs. 17.4+/-0.7 ml/kg/min, P=0.6), however, did not differ. Longitudinal systolic velocities of the basal septum (SSm: 6.9+/-0.9 vs. 6.1+/-0.8 cm/s, P=0.07), basal left lateral (LSm: 6.1+/-1.3 vs. 5.9+/-0.8 cm/s, P=0.3) and basal right ventricular free wall (RVSm: 11.7+/-0.9 vs. 10.1+/-0.7 cm/s, P<0.01) remained unchanged or decreased. Inter-ventricular (Deltat LSm-RVSm) (10+/-18 vs. 15+/-9 ms) and intra-ventricular mechanical delay (Deltat SSm-LSm) (10+/-15 vs. 9+/-6 ms) did not change. CONCLUSION: RAP resulted in a net increase in CO, without an acute favourable effect on exercise capacity. This finding underscores the importance of peripheral factors (endothelial and skeletal muscle dysfunction) as determinants of exercise capacity in CHF. The fact that longitudinal systolic myocardial velocities at higher HR did not change or even decreased suggests that a blunted FFR still occurs, despite CRT. RAP had no effect on mechanical synchrony. |
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Authors:
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Griet Van Thielen; Bernard P Paelinck; Paul Beckers; Beckers Paul; Christiaan J Vrints; Viviane M A Conraads |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology Volume: 15 ISSN: 1741-8267 ISO Abbreviation: Eur J Cardiovasc Prev Rehabil Publication Date: 2008 Apr |
Date Detail:
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Created Date: 2008-04-08 Completed Date: 2008-07-17 Revised Date: 2008-09-04 |
Medline Journal Info:
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Nlm Unique ID: 101192000 Medline TA: Eur J Cardiovasc Prev Rehabil Country: England |
Other Details:
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Languages: eng Pagination: 197-202 Citation Subset: IM |
Affiliation:
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Department of Cardiology, University Hospital Antwerp, Belgium. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cardiac Output* Cardiac Pacing, Artificial* Chronic Disease Echocardiography, Doppler, Pulsed Exercise Test Exercise Tolerance* Female Heart Failure / physiopathology, therapy*, ultrasonography Heart Rate* Humans Male Middle Aged Myocardial Contraction Pilot Projects Stroke Volume Treatment Outcome Ventricular Function, Left* |
| Comments/Corrections | |
Erratum In:
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Eur J Cardiovasc Prev Rehabil. 2008 Aug;15(4):501 Note: Paul, Beckers [corrected to Beckers, Paul] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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