Prognostic effect and modulation of cardiac sympathetic function in heart failure patients treated with cardiac resynchronization therapy

被引:10
作者
Moreira, Rita Ilhao [1 ]
Abreu, Ana [1 ]
Portugal, Guilherme [1 ]
Oliveira, Luis [2 ]
Oliveira, Mario [1 ]
Rodrigues, Ines [1 ]
Cruz, Madalena Coutinho [1 ]
Cunha, Pedro Silva [1 ]
Santos, Vanessa [3 ]
Clara, Helena Santa [3 ]
Carmo, Miguel Mota [1 ,4 ]
Ferreira, Rui Cruz [1 ]
机构
[1] Hosp Santa Marta, Centro Hospitalar Lisboa Cent, Dept Cardiol, Rua Santa Marta, . 50, P-1169-024 Lisbon, Portugal
[2] Nucl Med Dept, Diag Clin Quadrantes, Med, Lisbon, Portugal
[3] Univ Lisbon, Human Kinet Fac, CIPER, Lisbon, Portugal
[4] Univ Nova Lisboa, NOVA Med Sch, Lisbon, Portugal
关键词
Heart failure; cardiac innervation; diagnostic and prognostic application; METAIODOBENZYLGUANIDINE UPTAKE; EUROPEAN ASSOCIATION; AMERICAN SOCIETY; NERVOUS ACTIVITY; ECHOCARDIOGRAPHY; RECOMMENDATIONS; DISINTEGRITY; IMPROVEMENT; PARAMETERS; OUTFLOW;
D O I
10.1007/s12350-018-1357-x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Cardiac autonomic dysfunction as assessed by I-123-metaiodobenzylguanidine (I-123-mIBG) scintigraphy is associated with poor prognosis in heart failure (HF) patients. Although cardiac resynchronization therapy (CRT) has emerged as an effective therapy in improving outcomes on HF patients, its effect on cardiac sympathetic nervous function is still not fully understood. We aimed to study the value of pre-implantation I-123-mIBG late heart-to-mediastinum ratio (HMR) as a predictor of response and outcomes after CRT and to correlate modification in this parameter with CRT response and functional improvement. Methods and Results BETTER-HF (Benefit of exercise training therapy and cardiac resynchronization in HF patients) is a prospective randomized clinical trial including HF patients submitted CRT (mean LVEF 24 +/- 8%, 74% NYHA class >= III) who underwent a clinical, echocardiographic, and scintigraphic assessment before and 6 months after CRT. One-hundred and twenty-one patients were included. Echocardiographic response was observed in 54% and composite outcome of cardiac mortality, cardiac transplant or heart failure hospitalization in 24% of patients. Baseline late HMR was an independent predictor of CRT response (regression coefficient 2.906, 95% CI 0.293-3.903, P .029) and outcomes (HR 0.066 95% CI 0.005-0.880, P .040). At follow-up, I-123-mIBG imaging showed positive changes in cardiac sympathetic nerve activity only in responders to CRT (1.36 +/- 0.14 prior vs. 1.42 +/- 0.16 after CRT, P .039). There was a significant correlation between improvement in late HMR and improvement in peak oxygen consumption (r 0.547, P < .001). Conclusion In our study, baseline cardiac denervation predicted response and clinical outcomes after CRT implantation. Cardiac sympathetic function was improved only in patients who responded to CRT and these positive changes were correlated with improvement in functional capacity.
引用
收藏
页码:283 / 290
页数:8
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