Key result
Baseline endothelial dysfunction predicts ~251% higher odds of CRT response at 6 months.
Why the study?
Does baseline endothelial dysfunction measured by fingertip RH-PAT score predict response to cardiac resynchronization therapy in patients with heart failure?
Observational (n=63)
Does baseline endothelial dysfunction measured by fingertip RH-PAT score predict response to cardiac resynchronization therapy in patients with heart failure?
Answers are grounded in this paper and cite their sources.
Endothelial dysfunction detected by fingertip RH-PAT prior to CRT implantation independently predicts echocardiographic response and reverse remodeling at 6 months.
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
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Okutucu et al. (2018) conducted an observational in Heart failure (n=63). Baseline endothelial dysfunction (RH-PAT score < 1.7) vs. RH-PAT score ≥ 1.7 was evaluated on CRT response (reduction in LV end-systolic volume ≥ 15% at 6 months) (OR 3.512, 95% CI 1.231-11.477, p=0.032). Baseline endothelial dysfunction (RH-PAT score < 1.7) independently predicted response to cardiac resynchronization therapy at 6 months (OR 3.512; 95% CI 1.231-11.477; p=0.032).
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