Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
J Cardiol. 2011 Jul;58(1):69-73. doi: 10.1016/j.jjcc.2011.01.010. Epub 2011 Apr 13.
Cardiac resynchronization therapy (CRT) is a beneficial strategy to improve severe cardiac dysfunction in patients with congestive heart failure (CHF). The improvement of endothelial function in CHF patients treated with CRT is reflected in the mortality risk reduction. However the precise mechanisms of the relationship between CRT and vascular endothelial function have not been well discussed.
Twenty-two severe consecutive CHF patients associated with dilated cardiomyopathy [New York Heart Association (NYHA) class 3.3 ± 0.5, left ventricular ejection fraction (LVEF) 24.4 ± 5.9%] were included in this study. We evaluated endothelial function, measured by reactive hyperemia peripheral arterial tonometry (RH-PAT), between optimal medical therapy alone group (medical therapy group: n = 10) and CRT group (n = 12) at the study enrolment and 12 weeks later. Furthermore we analyzed the association between the RH-PAT and cardiac function.
Both therapies significantly and equally improved NYHA class, LVEF, end-diastolic left ventricular dimension and plasma levels of brain natriuretic peptide (BNP). CRT significantly increased RH-PAT index (medical therapy group: 1.5 ± 0.2 to 1.5 ± 0.3, p = 0.824; CRT group: 1.4 ± 0.2 to 1.7 ± 0.4, p = 0.003) and cardiac output (medical therapy group: 3.3 ± 1.1 to 3.5 ± 1.0, p = 0.600; CRT group: 2.7 ± 0.6 to 4.3 ± 1.5, p = 0.001), compared to the medical therapy group. There was significant positive correlation between the change in RH-PAT index and cardiac output (r = 0.600, p = 0.003).
CRT significantly improved endothelial function through the improvement of cardiac output in CHF patients, compared to optimal medical therapy.
心脏再同步治疗（CRT）是改善充血性心力衰竭（CHF）患者严重心功能障碍的有益策略。接受 CRT 治疗的 CHF 患者内皮功能的改善反映在降低死亡率风险上。然而，CRT 与血管内皮功能之间关系的确切机制尚未得到很好的讨论。
本研究纳入了 22 例连续的严重 CHF 患者（纽约心脏协会（NYHA）心功能分级 3.3 ± 0.5，左心室射血分数（LVEF）24.4 ± 5.9%），这些患者均伴有扩张型心肌病。我们在研究入组时和 12 周后，分别评估了单独接受最佳药物治疗组（药物治疗组：n = 10）和 CRT 组（n = 12）的内皮功能，内皮功能通过反应性充血外周动脉张力测定（RH-PAT）来测量。此外，我们还分析了 RH-PAT 与心功能之间的关系。
两种治疗方法均显著且同等地改善了 NYHA 心功能分级、LVEF、舒张末期左心室内径和血浆脑利钠肽（BNP）水平。CRT 显著增加了 RH-PAT 指数（药物治疗组：1.5 ± 0.2 至 1.5 ± 0.3，p = 0.824；CRT 组：1.4 ± 0.2 至 1.7 ± 0.4，p = 0.003）和心输出量（药物治疗组：3.3 ± 1.1 至 3.5 ± 1.0，p = 0.600；CRT 组：2.7 ± 0.6 至 4.3 ± 1.5，p = 0.001），与药物治疗组相比。RH-PAT 指数的变化与心输出量之间存在显著的正相关（r = 0.600，p = 0.003）。
与最佳药物治疗相比，CRT 通过改善心输出量显著改善了 CHF 患者的内皮功能。
