Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Karamichalakis Nikolaos
Dissertation committee:
Γεράσιμος Φιλιππάτος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Παρασκευαΐδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Παρίσης,Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Τσιούφης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χαράλαμπος Βλαχόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιγνάτιος Οικονομίδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Γκατζούλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Επίδραση της θεραπείας καρδιακού επανασυγχρονισμού στη λειτουργία του αγγειακού δικτύου
Translated title:
Effect of cardiac resynchronization therapy in vascular function
Summary:
Objectives: The purpose of this study is to evaluate the impact of Cardiac resynchronization therapy (CRT) in endothelial dysfunction (ED) and to determine predictors of response to CRTBackground: ED is a hallmark of chronic heart failure (CHF) and has been related with disease progression, increase in hospitalizations and mortality.
Methods: CHF patients who received CRT from 19/07/2016 until 19/10/2018 were studied at baseline and 3 months after. In each visit we evaluated a 12 lead ECG, carotid to femoral pulse wave velocity (cfPWV), flow-mediated dilatation of the brachial artery (FMD), left ventricle ejection fraction (LVEF) and left ventricle (LV) global longitudinal strain (GLS). We evaluated arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography and the ratio of cfPWV to GLS, as valid markers of ventricular-arterial interaction. We also assessed the layer of endothelial glycocalyx by measurement of Perfused Boundary Region (PBR) of the sublingual microvessel range:5-25 microns.
Results: 32 patients with a mean age 65.5 (±10.9) years and severe LV systolic dysfunction (baseline LVEF: 27 ± 7%, LVESV: 151 ± 42 ml, GLS: 6.47 ± 2.89%) were followed-up for a median of 115 days (IQR: 36). During follow-up, LVEF and GLS were significantly increased (mean change: 7.50 ± 4.77% and 2.85 ±2.28% respectively) and LVESV was significantly reduced (mean change: -26.91 ±17.20 ml). All markers of ED exhibited significant change: FMD was increased by 4.37 ± 3.34% (p<0.001), PBR decreased by 0.13 ± 0.25 microns (p=0.028), while Ea/Ees was reduced by 0.77 ± 0.47% (p<0.001) and cfPWV by 1.10 ± 1.56 (p=0.003). 23 of 32 patients were responders. Among the baseline vascular function markers, only the ratio cfPWV/GLS predicted the response to CRT (OR: 0.245, 95%CI: 0.042-0.759, p=0.044). Threshold analysis showed that the best threshold of cfPWV/GLS was- 2.75 (specificity: 0.67%, sensitivity: 0.94%) for the response to CRT.
Conclusions: After 3 months of CRT, endothelial function, arterial elasticity and ventricular arterial interaction is improved in CHF patients. The baseline ratio cfPWV/GLS, a novel marker of ventricular arterial interaction, can be applied to predict response to CRT.
Main subject category:
Health Sciences
Keywords:
Heart failure, Cardiac resynchronization therapy, Cardiology
Number of references:
190
