Cardiac resynchronization therapy modifies the neurohormonal profile, hemodynamic and functional capacity in heart failure patients.
BACKGROUND
Cardiac resynchronization therapy (CRT) has been shown to improve the clinical status and survival in congestive heart failure (CHF) patients, but little is known about its influence on neurohormonal profile.


METHODS
Heart failure patients treated with CRT for moderate/severe heart failure were studied with echocardiography, cardiopulmonary test, and neurohormonal profile [brain natriuretic peptide (BNP), endothelin (END), big endothelin (big-END), epinephrine (EPI), tumor necrosis factor-alpha (TNF-alpha)] at baseline and after 1 year from the pacemaker implantation.


RESULTS
120 NYHA II-IV patients entered this study, all with an indication to CRT; 100 agreed to be implanted (group A), whereas 20 refused, identifying a control group (group B). In group A NYHA class (from 3.15+/-0.49-1.15+/-0.49, p=0.001), left ventricular ejection fraction (from 19.6+/-4.95-35.6+/-5.95%, p=0.001), severity of mitral regurgitation (from 13.3+/-4.19-6.09+/-4.11 cmq, p=0.001), and peak VO(2) (from 9.68+/-4.61-13.35+/-3.32 mL/kg/min, p=0.001) improved at 1-year follow-up. In the neurohormonal profile only plasma BNP (from 185.1+/-185.9-110.2+/-137.5 pg/mL, p=0.03) and big-END (from 1.8+/-1.5-0.87+/-0.7 fmol/mL, p=0.007) were reduced significantly. None of these parameters significantly changed in the control group at 1-year follow-up.


CONCLUSIONS
In patients with moderate/severe heart failure, CRT improved clinical status and the functional parameters modifying the neurohormonal profile at 1-year follow-up.
Menardi
Endrj
E
Department of Cardiovascular Diseases, Ospedale S. Croce-Carle, Cuneo, Italy.
Vado
Antonello
A
Rossetti
Guido
G
Racca
Emanuela
E
Conte
Enrica
E
Deorsola
Antonella
A
Bobbio
Marco
M
Feola
Mauro
M