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


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).


CONCLUSIONS
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.
Flevari
Panayota
P
2nd Cardiac Clinic, Onassis Cardiac Surgery Center, Sygrou 356, Athens, Greece. pfelvari@yahoo.com
Theodorakis
George
G
Paraskevaidis
Ioannis
I
Kolokathis
Fotis
F
Kostopoulou
Anna
A
Leftheriotis
Dionyssios
D
Kroupis
Christos
C
Livanis
Efthimios
E
Kremastinos
Dimitrios T
DT
D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D002304:Cardiac Pacing, Artificial; D003326:Coronary Circulation; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D016014:Linear Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010101:Oxygen Consumption; D010991:Plethysmography; D011379:Prognosis; D016896:Treatment Outcome; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D015415:Biomarkers; D019010:Vascular Cell Adhesion Molecule-1; D020097:Natriuretic Peptide, Brain; D018799:Intercellular Adhesion Molecule-1