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Resynchronization improves heart-arterial coupling reducing arterial load determinants.
MedLine Citation:
PMID:  23143859     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Cardiac resynchronization therapy (CRT) has benefits on left ventricle (LV) performance, but its mid-term effects on LV load and LV-arterial coupling are unknown.AIMS: To evaluate CRT mid-term effects on LV-arterial coupling, arterial load and its determinants, and the association between CRT-dependent aortic haemodynamic changes and the arterial biomechanics.METHODS AND RESULTS: Cardiac and aortic echographies were done in 25 patients (age: 61 ± 12 years; 14 men; New York Heart Association functional classes III-IV; LV ejection fraction = 28 ± 7%, QRS = 139 ± 20 ms) before and after (23 ± 12 days) CRT. Standard structural and functional parameters and dyssynchrony indices were evaluated. Ascending aorta flow and diameter waveforms were measured. Central pressure was derived using a transfer function and the diameter calibration method. Calculus: arterial elastance (E(A)); aortic impedance (Zc) and distensibility (AD); systemic resistances (SVR), total compliance (C(T)); global reflection coefficient; LV end-systolic elastance (E(ES)); and LV-arterial coupling (E(A)/E(ES)). After CRT E(A) diminished (-30%;P = 0.001), E(ES) increased (29%; P = 0.001) and E(A)/E(ES) improved (pre-CRT: 2.9 ± 0.9, post-CRT: 1.6 ± 0.7; P = 0.001). Arterial elastance changes were associated with changes in arterial properties. Cardiac resynchronization therapy was associated with pressure-independent increase in mean aortic diameter (pre-CRT: 30.0 ± 4.0 mm, post-CRT: 33.0 ± 5.1 mm; P = 0.005) and distensibility (pre-CRT: 3.8 ± 2.6 × 10(-3)mmHg(-1), post-CRT: 6.4 ± 2.5 × 10(-3) mmHg(-1); P = 0.002), and Zc reduction (pre-CRT: 3.5 ± 1.8 × 10(-2)mmHg.s/mL, post-CRT:1.9 ± 0.8 × 10(-2) mmHg.s/mL; P = 0.001) and SVR (pre-CRT:1.7 ± 0.4 mmHg.s/mL, post-CRT:1.0 ± 0.3 mmHg.s/mL; P = 0.001). Changes in E(A) determinants were associated with changes in aortic flow.CONCLUSION: Early after CRT central and peripheral arterial biomechanics improved, determining a pressure-independent increase in aortic diameter and a reduction in arterial load. Left ventricular systolic performance and LV-arterial coupling were enhanced. Arterial biomechanical changes were associated with aortic flow changes.
Authors:
Yanina Zócalo; Daniel Bia; Ricardo L Armentano; Juan González-Moreno; Gonzalo Varela; Fernando Calleriza; Walter Reyes-Caorsi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-9
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Physiology Department, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), School of Medicine, Universidad de la República, General Flores 2125, Montevideo PC: 11800, República Oriental del Uruguay.
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