Journal Article

Coronary and peripheral blood flow changes following biventricular pacing and their relation to heart failure improvement

Panayota Flevari, George Theodorakis, Ioannis Paraskevaidis, Fotis Kolokathis, Anna Kostopoulou, Dionyssios Leftheriotis, Christos Kroupis, Efthimios Livanis and Dimitrios T. Kremastinos

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 8, issue 1, pages 44-50
Published in print January 2006 | ISSN: 1099-5129
Published online January 2006 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/euj015
Coronary and peripheral blood flow changes following biventricular pacing and their relation to heart failure improvement

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Aims To study the effect of cardiac resynchronization therapy (CRT) on coronary and peripheral arterial circulation and to assess whether their changes are related to the improvement in patients' functional capacity and prognostically important biochemical markers.

Methods and results Twenty-five patients were studied (New York Heart Association classes III and IV, left ventricular ejection fraction <35%, QRS>120 ms, mean age 66±2.1 years). Coronary blood flow (CBF), forearm blood flow (FBF), and their reserve were measured by transoesophageal echocardiography (in cm/s) and venous occlusion plethysmography (in mL/100 mL/min) at baseline and following 3 months of CRT. N-terminal-pro-brain natriuretic peptide (Nt-pro-BNP) and serum adhesion molecules, sICAM-1 and sVCAM-1 levels were also assessed. CRT induced a non-significant increase in resting CBF (baseline vs. CRT: 52.1±5.5 vs. 58.2±3.6, P: NS), whereas hyperaemic CBF was increased by CRT (baseline vs. CRT: 67.8±6.8 vs. 79.8±6.2, P<0.05). Significant increases were observed in resting FBF (baseline vs. CRT: 1.6±0.2 vs. 2.6±0.2, P<0.05) and hyperaemic FBF (baseline vs. CRT: 2.1±0.2 vs. 3.2±0.3, P<0.05). The per cent difference in hyperaemic FBF was related to the per cent change in Nt-pro-BNP (r=−0.71, P<0.05) and the per cent improvement in exercise duration (r=0.80, P<0.05).

Conclusion CRT induces favourable changes in coronary and peripheral arterial function. Changes in peripheral blood flow are related to patients' improvement and may be prognostically significant.

Keywords: Heart failure; Pacing; Blood flow

Journal Article.  3519 words.  Illustrated.

Subjects: Cardiovascular Medicine

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