title: Improvement effect on endothelial function in patients with congestive heart failure treated with cardiac resynchronization therapy.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) is a beneficial strategy to improve severe cardiac dysfunction in patients with congestive heart failure (CHF). The improvement of endothelial function in CHF patients treated with CRT is reflected in the mortality risk reduction. However the precise mechanisms of the relationship between CRT and vascular endothelial function have not been well discussed.
  
  
  METHODS
  Twenty-two severe consecutive CHF patients associated with dilated cardiomyopathy [New York Heart Association (NYHA) class 3.3 ± 0.5, left ventricular ejection fraction (LVEF) 24.4 ± 5.9%] were included in this study. We evaluated endothelial function, measured by reactive hyperemia peripheral arterial tonometry (RH-PAT), between optimal medical therapy alone group (medical therapy group: n = 10) and CRT group (n = 12) at the study enrolment and 12 weeks later. Furthermore we analyzed the association between the RH-PAT and cardiac function.
  
  
  RESULTS
  Both therapies significantly and equally improved NYHA class, LVEF, end-diastolic left ventricular dimension and plasma levels of brain natriuretic peptide (BNP). CRT significantly increased RH-PAT index (medical therapy group: 1.5 ± 0.2 to 1.5 ± 0.3, p = 0.824; CRT group: 1.4 ± 0.2 to 1.7 ± 0.4, p = 0.003) and cardiac output (medical therapy group: 3.3 ± 1.1 to 3.5 ± 1.0, p = 0.600; CRT group: 2.7 ± 0.6 to 4.3 ± 1.5, p = 0.001), compared to the medical therapy group. There was significant positive correlation between the change in RH-PAT index and cardiac output (r = 0.600, p = 0.003).
  
  
  CONCLUSIONS
  CRT significantly improved endothelial function through the improvement of cardiac output in CHF patients, compared to optimal medical therapy.
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Enomoto
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Yamabe
authors.forename: Kensuke
authors.initials: K
authors.lastname: Toyama
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsuzawa
authors.forename: Megumi
authors.initials: M
authors.lastname: Yamamuro
authors.forename: Takashi
authors.initials: T
authors.lastname: Uemura
authors.forename: Kenji
authors.initials: K
authors.lastname: Morihisa
authors.forename: Satomi
authors.initials: S
authors.lastname: Iwashita
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaikita
authors.forename: Seigo
authors.initials: S
authors.lastname: Sugiyama
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D002302:Cardiac Output / Q000502:physiology; D058406:Cardiac Resynchronization Therapy; D002311:Cardiomyopathy, Dilated / Q000150:complications; D004730:Endothelium, Vascular / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged