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Effects of cardiac resynchronization therapy on right ventricular function during rest and exercise, as assessed by radionuclide angiography, and on NT-proBNP levels

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Journal of Nuclear Cardiology Aims and scope

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.

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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

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Acknowledgments

The authors are grateful to Gabriele Cristiani for skilled graphic support.

Disclosure

None to declare.

Author information

Authors and Affiliations

  1. Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Cinzia Valzania MD, PhD, Mauro Biffi MD, Francesco Fallani MD, Cristian Martignani MD, PhD, Igor Diemberger MD, PhD, Matteo Ziacchi MD, PhD, Jessica Frisoni BS, Luciana Tomasi BS & Claudio Rapezzi MD

  2. Department of Nuclear Medicine, S.Orsola Malpighi Hospital, University of Bologna, Bologna, Italy

    Rachele Bonfiglioli MD & Stefano Fanti MD

  3. Division of Cardiology, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy

    Giuseppe Boriani MD, PhD

Authors
  1. Cinzia Valzania MD, PhD
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  2. Mauro Biffi MD
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  3. Rachele Bonfiglioli MD
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  4. Francesco Fallani MD
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  5. Cristian Martignani MD, PhD
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  6. Igor Diemberger MD, PhD
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  7. Matteo Ziacchi MD, PhD
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  8. Jessica Frisoni BS
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  10. Stefano Fanti MD
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  12. Giuseppe Boriani MD, PhD
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Correspondence to Cinzia Valzania MD, PhD.

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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

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  • DOI: https://doi.org/10.1007/s12350-017-0971-3

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