Okutucu Sercan, Jam Farzin, Sabanoglu Cengiz, Yetis Sayin Begum, Aksoy Hakan, Ercan Akgul Ebru, Oto Ali
Department of Cardiology, Memorial Ankara Hospital, Ankara.
Department of Cardiology, Akademi Hospital, Kocaeli.
Acta Cardiol Sin. 2018 Nov;34(6):488-495. doi: 10.6515/ACS.201811_34(6).20180518A.
The objectives of this study were to: (i) evaluate endothelial function via fingertip reactive hyperemia peripheral arterial tonometry (RH-PAT) among heart failure (HF) patients receiving cardiac resynchronization therapy (CRT), (ii) assess the effects of CRT on RH-PAT score, and (iii) investigate whether RH-PAT score can identify CRT response.
A total of 63 patients (61.8 ± 10.3 years; 50 males; left ventricular (LV) ejection fraction 24.3 ± 3.9%) with HF who received CRT were enrolled. Endothelial function via RH-PAT was assessed 1 day before and 6 months after CRT. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) was used to assess clinical improvements. CRT response was defined as a reduction in LV end-systolic volume ≥ 15% at 6 months.
A RH-PAT score of < 1.7 signified a cut-off for endothelial dysfunction (ED). Baseline ED was observed among 43 (68.3%) patients and was more prevalent in responders (76.1% vs. 47.1%, p = 0.037). RH-PAT score improved 6 months after CRT (1.58 ± 0.35 vs. 1.71 ± 0.31, p = 0.012). A RH-PAT score of < 1.7 was a significant independent predictor of CRT response in multivariate logistic regression analysis (β = 1.275, OR = 3.512, 95% CI = 1.231-11.477, p = 0.032). The severity of ED was an independent predictor of LV reverse remodeling (β = -8.873, p = 0.015). Spearman's correlation analysis revealed moderate positive correlations between an improvement in RH-PAT (ΔRH-PAT) and LV reverse remodeling (r = 0.461, p = 0.001) and MLWHFQ score (r = 0.440, p = 0.001).
ED detected via RH-PAT could predict the response to CRT. The RH-PAT score increased 6 months after CRT and was correlated with echocardiographic and clinical improvements.
本研究的目的是：（i）在接受心脏再同步治疗（CRT）的心力衰竭（HF）患者中，通过指尖反应性充血外周动脉张力测定法（RH-PAT）评估内皮功能；（ii）评估CRT对RH-PAT评分的影响；（iii）研究RH-PAT评分是否能够识别CRT反应。
共纳入63例接受CRT的HF患者（年龄61.8±10.3岁；男性50例；左心室（LV）射血分数24.3±3.9%）。在CRT前1天和CRT后6个月通过RH-PAT评估内皮功能。采用明尼苏达心力衰竭生活问卷（MLWHFQ）评估临床改善情况。CRT反应定义为6个月时LV收缩末期容积减少≥15%。
RH-PAT评分<1.7表示内皮功能障碍（ED）的临界值。43例（68.3%）患者存在基线ED，且在反应者中更常见（76.1%对47.1%，p = 0.037）。CRT后6个月RH-PAT评分有所改善（1.58±0.35对1.71±0.31，p = 0.012）。在多因素逻辑回归分析中，RH-PAT评分<1.7是CRT反应的显著独立预测因素（β = 1.275，OR = 3.512，95%CI = 1.231-11.477，p = 0.032）。ED的严重程度是LV逆向重构的独立预测因素（β = -8.873，p = 0.015）。Spearman相关性分析显示，RH-PAT改善（ΔRH-PAT）与LV逆向重构（r = 0.461，p = 0.001）和MLWHFQ评分（r = 0.440，p = 0.001）之间存在中度正相关。
通过RH-PAT检测到的ED可以预测对CRT的反应。CRT后6个月RH-PAT评分升高，且与超声心动图和临床改善相关。
