title: Acute effects of cardiac resynchronization therapy on arterial distensibility and serum norepinephrine levels in advanced heart failure.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) has become an accepted method for treating refractory heart failure (HF). Arterial distensibility is an index of arterial stiffness and a surrogate marker for atherosclerosis. The present study aims to assess the acute effects of ventricular resynchronization therapy with biventricular stimulation on arterial distensibility, echocardiographic parameters and serum norepinephrine levels in patients with drug refractory HF.
  
  
  METHODS
  Fourteen cardiac HF patients (53.6 ± 9.1; 39-67 years, 7 woman) were enrolled for CRT. Patients had an advanced cardiac HF (NYHA III-IV functional class) due to non-ischemic dilated cardiomyopathy, with a left ventricular ejection fraction (LVEF) < 35% and QRS duration ≥120 ms. Blood samples for norepinephrine and B-type natriuretic peptide were collected before 24 h biventricular implantation and after 48 h of CRT. Transthoracic echocardiography was used to evaluate arterial distensibility and cardiovascular condition.
  
  
  RESULTS
  Although systolic blood pressure, diastolic blood pressure, LV end-diastolic diameter, LV end-systolic diameter, serum B-type natriuretic peptide, and serum norepinephrine levels significantly decreased after CRT implantation; EF and aortic distensibility significantly increased (p < 0.05). There was no significance in the hemodynamic and echocardiographic values, norepinephrine and B-type natriuretic peptide levels in pre- and post-CRT between man and woman.
  
  
  CONCLUSIONS
  The major findings of this study are that in patients with cardiac HF in acute period, after implantation of CRT serum norepinephrine levels decrease and the arterial distensibility improves.
authors.affiliation: Internal Medicine Specialist and Physiologist, Bayar Cad Gülbahar Sok Emniyet Sitesi D6, Kozyatağı, İstanbul. mustafayilldiz@yahoo.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yildiz
authors.forename: Hakan
authors.initials: H
authors.lastname: Hasdemir
authors.forename: Ceyhan
authors.initials: C
authors.lastname: Turkkan
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Astarcioglu
authors.forename: Ahmet Taha
authors.initials: AT
authors.lastname: Alper
authors.forename: Alparslan
authors.initials: A
authors.lastname: Sahin
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozkan
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D058406:Cardiac Resynchronization Therapy; D003187:Compliance; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000097:blood*; D011446:Prospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D059289:Vascular Stiffness; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D009638:Norepinephrine