title: Endothelial Function Predicts New Hospitalization due to Heart Failure Following Cardiac Resynchronization Therapy.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) has been established as a treatment for patients with chronic heart failure (HF). We tested the hypothesis that assessment of peripheral endothelial function is associated with the long-term outcome of CRT and its linkage to coronary flow reserve (CFR) was also investigated.
  
  
  METHODS
  From 2010, a total of 34 consecutive patients implanted with CRT for the treatment of advanced HF were evaluated at baseline (immediately before CRT) and 6-8 months after CRT. Endothelial function was evaluated by measurement of reactive hyperemia peripheral arterial tonometry (RH-PAT). In 24 of 34 patients, CFR was determined by transthoracic echocardiography.
  
  
  RESULTS
  Based on the receiver-operating characteristic curves, depressed RH-PAT index (RHI) was defined as ≤1.5. Accurate follow-up information during the mean of 343 ± 120 days was obtained in 20 preserved RHI group (mean age 66 ± 1.8 years) and 14 depressed RHI group (71 ± 2.2 years). Kaplan-Meier survival analysis demonstrated that depressed RHI group had higher prevalence of new hospitalization due to HF progression (log-rank 5.40). Cox proportional hazards regression analysis revealed that the baseline log brain natriuretic peptide (hazard ratio 5.95) and the baseline RHI value (hazard ratio 0.066) were independently associated with the incidence of new hospitalization due to HF progression. The baseline RHI values were positively correlated with the 6-8 months change of CFR (R = 0.434, P = 0.0343).
  
  
  CONCLUSIONS
  Our results suggest that the baseline peripheral endothelial function could predict the long-term outcome of CRT. The results also suggest that improvement of coronary microcirculation might be associated with the better baseline endothelial function.
authors.affiliation: From the Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Yufu
authors.affiliation: From the Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Shinohara
authors.affiliation: From the Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ebata
authors.affiliation: From the Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors.forename: Reika
authors.initials: R
authors.lastname: Ayabe
authors.affiliation: From the Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fukui
authors.affiliation: From the Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Okada
authors.affiliation: From the Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: From the Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011379:Prognosis; D016896:Treatment Outcome
keywords: cardiac resynchronization therapy; coronary flow reserve; endothelial function; long-term outcome