title: Rate response and cardiac resynchronisation therapy in chronic heart failure: higher cardiac output does not acutely improve exercise performance: a pilot trial.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, University Hospital Antwerp, Belgium.
authors.forename: Griet
authors.initials: G
authors.lastname: Van Thielen
authors.forename: Bernard P
authors.initials: BP
authors.lastname: Paelinck
authors.forename: Paul
authors.initials: P
authors.lastname: Beckers
authors.forename: Beckers
authors.initials: B
authors.lastname: Paul
authors.forename: Christiaan J
authors.initials: CJ
authors.lastname: Vrints
authors.forename: Viviane M A
authors.initials: VM
authors.lastname: Conraads
mesh_terms: D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial; D002908:Chronic Disease; D018619:Echocardiography, Doppler, Pulsed; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D010865:Pilot Projects; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left