A Novel and Simple Exercise Test Parameter to Assess Responsiveness to Cardiac Resynchronization Therapy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Strategy Implantation
2.2. ECG Evaluation
2.3. Transthoracic Echocardiography (TTE)
2.4. Exercise Test (ET)
2.5. Device Programming
2.6. Response to CRT
- -
- Clinical response to CRT, defined as improvement in NYHA functional class, ET duration, and workload.
- -
- Echocardiographic response (defined as >5% increase in LVEF, 15% decrease in LV end-systolic/diastolic volume, and decreased mitral regurgitation degree).
- -
- Assessment of outcomes: number of hospitalizations due to worsening heart failure, all-cause mortality, and morbidity.
2.7. Statistical Analysis
3. Results
3.1. Baseline Demographic Data
3.2. Results: ECG and Echocardiography
3.3. Exercise Test Results
3.4. Device Programming
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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All Patients (n = 109) | |
---|---|
Mean age (years) | 63.32 ± 9.8 |
Male, n (%) | 74 (68) |
NYHA functional class n (%) | |
II | 9 (8) |
III | 83 (76) |
IV | 18 (16) |
Hypertension, n (%) | 85 (77.3) |
Chronic kidney disease, n (%) * | 61 (56) |
Diabetes mellitus, n (%) | 40 (36) |
Dyslipidemia, n (%) | 89 (81.3) |
Medication, n (%) | |
ACEI/ARB | 99 (90.7) |
Beta-blockers | 90 (82.7) |
Ivabradine | 31 (28) |
Diuretics | 102 (93.3) |
Aldosterone receptor antagonists | 89 (81.3) |
Digoxin | 5 (4) |
All Patients (n = 109) | Range | ||
---|---|---|---|
LVEDD (cm), mean ± SD | 6.44 ± 0.95 | 4.5–8.9 | |
LVEDV (mL), mean ± SD | 240.32 ± 90.7 | 90–560 | |
LVESV (mL), mean ± SD | 176.45 ± 72.6 | 43–414 | |
EF (%), mean ± SD | 26.75 ± 5.8 | 15–40 | |
LAV (mL), mean ± SD | 120.73 ± 58.7 | 49–440 | |
Valvular disease, n (%) | Mild | Moderate | Severe |
Mitral regurgitation | 64 (58.7) | 24 (21.3) | 22 (20) |
Tricuspid regurgitation | 85 (77.4) | 22 (20) | 3 (2.7) |
Aortic regurgitation | 24 (21.3) | 2 (1.3) | 0 |
Aortic stenosis | 3 (2.7) | 0 | 0 |
Asynchronism parameters | Interventricular asynchronism n (%) | ||
50 (46) | |||
Intraventricular asynchronism n (%) | |||
42 (38) | |||
Septal flash n (%) | |||
58 (53) |
Before CRT | After CRT | p-Value | |
---|---|---|---|
LVEF (%) | 26 ± 5.8 | 35 ± 8.7 | <0.001 |
LVESV (mL) | 176 ± 72 | 145 ± 73 | <0.001 |
LVEDV (mL) | 240 ± 90 | 217 ± 89 | <0.001 |
LVEDD (cm) | 6.4 ± 0.95 | 6.1 ± 1.1 | <0.001 |
QRS interval (ms) | 168.89 ± 30.4 | 134.22 ± 20.4 | <0.001 |
QRS axis (°) | −18 ± 36 | +38 ± 105 | <0.001 |
Parameter | Responders (n = 98) | Non-Responders (n = 11) | p-Value |
---|---|---|---|
METs | 6.43 ± 1.2 | 6.04 ± 1.0 | 0.3 |
Watt | 111.16 ± 32.6 | 102.27 ± 23.5 | 0.4 |
Basal HR | 67.55 ± 10.2 | 63.64 ± 7.2 | 0.2 |
Maximum HR | 100.55 ± 21.8 | 88.90 ± 10.7 | 0.09 |
AT | 303.66 ± 125.9 | 303.7 ± 96.9 | 0.9 |
DT | 125.86 ± 77.4 | 241.68 ± 116.6 | <0.001 |
HRRI = AT/DT | 3.16 ± 2.0 | 1.4 ± 0.5 | 0.007 |
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Cozlac, A.-R.; Petrescu, L.; Crisan, S.; Luca, C.T.; Vacarescu, C.; Streian, C.G.; Lazar, M.-A.; Gurgu, A.; Dragomir, A.; Goanta, E.V.; et al. A Novel and Simple Exercise Test Parameter to Assess Responsiveness to Cardiac Resynchronization Therapy. Diagnostics 2020, 10, 920. https://doi.org/10.3390/diagnostics10110920
Cozlac A-R, Petrescu L, Crisan S, Luca CT, Vacarescu C, Streian CG, Lazar M-A, Gurgu A, Dragomir A, Goanta EV, et al. A Novel and Simple Exercise Test Parameter to Assess Responsiveness to Cardiac Resynchronization Therapy. Diagnostics. 2020; 10(11):920. https://doi.org/10.3390/diagnostics10110920
Chicago/Turabian StyleCozlac, Alina-Ramona, Lucian Petrescu, Simina Crisan, Constantin Tudor Luca, Cristina Vacarescu, Caius Glad Streian, Mihai-Andrei Lazar, Andra Gurgu, Angela Dragomir, Emilia Violeta Goanta, and et al. 2020. "A Novel and Simple Exercise Test Parameter to Assess Responsiveness to Cardiac Resynchronization Therapy" Diagnostics 10, no. 11: 920. https://doi.org/10.3390/diagnostics10110920
APA StyleCozlac, A.-R., Petrescu, L., Crisan, S., Luca, C. T., Vacarescu, C., Streian, C. G., Lazar, M.-A., Gurgu, A., Dragomir, A., Goanta, E. V., Vatasescu, R., Chahine, K. M., Rachieru, C., & Cozma, D. (2020). A Novel and Simple Exercise Test Parameter to Assess Responsiveness to Cardiac Resynchronization Therapy. Diagnostics, 10(11), 920. https://doi.org/10.3390/diagnostics10110920