Circulation. 2003;107:28-31
Published online before print December 9, 2002, doi: 10.1161/01.CIR.0000047068.02226.95
Published online before print December 9, 2002, doi: 10.1161/01.CIR.0000047068.02226.95
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(Circulation. 2003;107:28.)
© 2003 American Heart Association, Inc.
Brief Rapid Communications |
Effect of Cardiac Resynchronization on Myocardial Efficiency and Regional Oxidative Metabolism
From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (H.U., R.S.B.B., I.B., R.A.d.K., A.S.L.T.); Divisions of Cardiology (E.F.) and Nuclear Medicine, McMaster University, Hamilton, Ontario, Canada (C.N.); and Heart Failure Research, Medtronic Inc, Minneapolis, Minn (M.R.S.H.).
Correspondence to Dr Anthony S. L. Tang, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa Ontario, Canada K1Y 4W7. E-mail atang{at}ottawaheart.ca
Background— Recent studies have demonstrated increased left ventricular contractility with cardiac resynchronization therapy (CRT) using atriobiventricular stimulation. This study evaluated the effect of CRT on myocardial oxidative metabolism and efficiency.
Methods and Results— Eight patients with New York Heart Association functional class III-IV congestive heart failure were studied during atrial pacing (control) and atriobiventricular stimulation at the same rate. The monoexponential clearance rate of [11C]acetate (kmono) was measured with positron emission tomography to assess myocardial oxidative metabolism in the left and right ventricles (LV and RV, respectively). Myocardial efficiency was measured using the work metabolic index (WMI). Stroke volume index improved by 10% (P=0.011) with CRT, although both global LV and RV kmono were unchanged compared with control. Septal kmono increased by 15% (P=0.04), and the septal/lateral wall kmono ratio increased by 22% (P=0.01). WMI increased by 13% (P=0.024) with CRT.
Conclusions— CRT improves LV function without increasing global LV oxidative metabolism, resulting in improved myocardial efficiency. Oxidative metabolism of the interventricular septum increases relative to the lateral wall, which suggests successful resynchronization.
Key Words: heart failure • pacemakers • oxygen • metabolism • tomography
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