Abstract
Aim
We carried out this study to investigate mid-term effects of cardiac resynchronization therapy (CRT) on right ventricular (RV) function and neurohormonal response, expressed by N-terminal pro-brain natriuretic peptide (NT-proBNP), in heart failure patients stratified by baseline RV ejection fraction (RVEF).
Methods and Results
Thirty-six patients with nonischemic dilated cardiomyopathy underwent technetium-99m radionuclide angiography with bicycle exercise immediately after CRT implantation (during spontaneous rhythm and after CRT activation) and 3 months later. Plasma NT proBNP was assessed before implantation and after 3 months. At baseline, RVEF was impaired (≤35%) in 14 patients, preserved (>35%) in 22. At 3 months, RVEF improved during rest and exercise (P = .02) in patients with impaired RV function, while remaining unchanged in patients with preserved RV function. Rest and exercise RV dyssynchrony decreased in both groups at follow-up (P < .05). A similar mid-term improvement in left ventricular (LV) function and NT-proBNP was observed in patients with impaired and preserved RVEF. In the former, the decrease in NT-proBNP correlated with the improvements both in LV and RV dyssynchrony and functions.
Conclusion
CRT may improve RV performance, during rest and exercise, and neurohormonal response in heart failure patients with nonischemic dilated cardiomyopathy and baseline RV dysfunction. RV dysfunction should not be considered per se a primary criterion for excluding candidacy to CRT.
Similar content being viewed by others
Abbreviations
- CRT:
-
Cardiac resynchronization therapy
- LV:
-
Left ventricular
- LVEF:
-
Left ventricular ejection fraction
- NT-proBNP:
-
N-terminal pro-brain natriuretic peptide
- RV:
-
Right ventricular
- RVEF:
-
Right ventricular ejection fraction
References
Ghio S, Recusani F, Klersy C, Sebastiani R, Laudisa ML, Campana C, et al. Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol 2000;85:837-42.
Linde C, Ellenbogen K, McAlister FA. Cardiac resynchronization therapy (CRT): Clinical trials, guidelines, and target populations. Heart Rhythm 2012;9:S3-13.
Boriani G, Fallani F, Martignani C, Biffi M, Saporito D, Greco C, et al. Cardiac resynchronization therapy: Effects on left and right ventricular ejection fraction during exercise. Pacing Clin Electrophysiol 2005;28:S11-4.
Bleeker GB, Schalij MJ, Nihoyannopoulos P, Steendijk P, Molhoek SG, van Erven L, et al. Left ventricular dyssynchrony predicts right ventricular remodeling after cardiac resynchronization therapy. J Am Coll Cardiol 2005;46:2264-9.
Rajagopalan N, Suffoletto MS, Tanabe M, Miske G, Thomas NC, Simon MA, et al. Right ventricular function following cardiac resynchronization therapy. Am J Cardiol 2007;100:1434-6.
Donal E, Thibault H, Bergerot C, Leroux PY, Cannesson M, Thivolet S, et al. Right ventricular pump function after cardiac resynchronization therapy: A strain imaging study. Arch Cardiovasc Dis 2008;101:475-84.
D’Andrea A, Scarafile R, Riegler L, Salerno G, Gravino R, Cocchia R, et al. Right atrial size and deformation in patients with dilated cardiomyopathy undergoing cardiac resynchronization therapy. Eur J Heart Fail 2009;11:1169-77.
Burri H, Domenichini G, Sunthorn H, Fleury E, Stettler C, Foulkes I, et al. Right ventricular systolic function and cardiac resynchronization therapy. Europace 2010;12:389-94.
Ogunyankin KO, Puthumana JJ. Effect of cardiac resynchronization therapy on right ventricular function. Curr Opin Cardiol 2010;25:464-8.
Sharma A, Bax JJ, Vallakati A, Goel S, Lavie CJ, Kassotis J, et al. Meta-analysis of the relation of baseline right ventricular function to response to cardiac resynchronization therapy. Am J Cardiol 2016;117:1315-21.
La Gerche A, Burns AT, Mooney DJ, Inder WJ, Taylor AJ, Bogaert J, et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J 2012;33:998-1006.
La Gerche A, Roberts T, Claessen G. The response of the pulmonary circulation and right ventricle to exercise: Exercise-induced right ventricular dysfunction and structural remodeling in endurance athletes (2013 Grover conference series). Pulm Circ 2014;4:407-16.
La Gerche A, Inder WJ, Roberts TJ, Brosnan MJ, Heidbuchel H, Prior DL. Relationship between inflammatory cytokines and indices of cardiac dysfunction following intense endurance exercise. PLoS ONE 2015;10:e0130031.
Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: The task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 2013;15:1070-118.
Valzania C, Fallani F, Gavaruzzi G, Biffi M, Martignani C, Diemberger I, et al. Radionuclide angiographic determination of regional left ventricular systolic function during rest and exercise in patients with nonischemic cardiomyopathy treated with cardiac Resynchronization therapy. Am J Cardiol 2010;106:389-94.
Domenichini G, Burri H, Valzania C, Gavaruzzi G, Fallani F, Biffi M, et al. QRS pattern and improvement in right and left ventricular function after cardiac resynchronization therapy: A radionuclide study. BMC Cardiovasc Disord 2012;12:27.
Fauchier L, Marie O, Casset-Senon D, Babuty D, Cosnay P, Fauchier JP. Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy: A prognostic study with fourier phase analysis of radionuclide angioscintigraphy. J Am Coll Cardiol 2002;40:2022-30.
Scuteri L, Rordorf R, Marsan NA, Landolina M, Magrini G, Klersy C, et al. Relevance of echocardiographic evaluation of right ventricular function in patients undergoing cardiac resynchronization therapy. Pacing Clin Electrophysiol 2009;32:1040-9.
Tabereaux PB, Doppalapudi H, Kay GN, McElderry HT, Plumb VJ, Epstein AE. Limited response to cardiac resynchronization therapy in patients with concomitant right ventricular dysfunction. J Cardiovasc Electrophysiol 2010;21:431-5.
Leong DP, Höke U, Delgado V, Auger D, Witkowski T, Thijssen J, et al. Right ventricular function and survival following cardiac resynchronisation therapy. Heart 2013;99:722-8.
Damy T, Ghio S, Rigby AS, Hittinger L, Jacobs S, Leyva F, et al. Interplay between right ventricular function and cardiac resynchronization therapy: An analysis of the CARE-HF trial (Cardiac Resynchronization-Heart Failure). J Am Coll Cardiol 2013;61:2153-60.
Mariano-Goulart D, Eberlé MC, Boudousq V, Hejazi-Moughari A, Piot C, Caderas de Kerleau C, et al. Major increase in brain natriuretic peptide indicates right ventricular systolic dysfunction in patients with heart failure. Eur J Heart Fail 2003;5:481-8.
Murninkas D, Alba AC, Delgado D, McDonald M, Billia F, Chan WS, et al. Right ventricular function and prognosis in stable heart failure patients. J Card Fail 2014;20:343-9.
Passino C, Sironi AM, Favilli B, Poletti R, Prontera C, Ripoli A, et al. Right heart overload contributes to cardiac natriuretic hormone elevation in patients with heart failure. Int J Cardiol 2005;104:39-45.
Wackers FJ. Equilibrium gated radionuclide angiocardiography: Its invention, rise, and decline and … comeback? J Nucl Cardiol 2016;23:362-5.
Normand C, Dickstein K. Predicting outcomes following CRT: The quest continues. Eur J Heart Fail 2015;17:645-6.
Herscovici R, Kutyifa V, Barsheshet A, Solomon S, McNitt S, Polonsky B, et al. Early intervention and long-term outcome with cardiac resynchronization therapy in patients without a history of advanced heart failure symptoms. Eur J Heart Fail 2015;17:964-70.
Acknowledgments
The authors are grateful to Gabriele Cristiani for skilled graphic support.
Disclosure
None to declare.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.”
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Valzania, C., Biffi, M., Bonfiglioli, R. et al. Effects of cardiac resynchronization therapy on right ventricular function during rest and exercise, as assessed by radionuclide angiography, and on NT-proBNP levels. J. Nucl. Cardiol. 26, 123–132 (2019). https://doi.org/10.1007/s12350-017-0971-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12350-017-0971-3