Abstract 5504: Comparison of the Improvement Effect on the Endothelial Function Between Congestive Heart Failure Patients Treated by the Medical Therapy and Cardiac Resynchronization Therapy
Background: Congestive heart failure is associated with endothelial dysfunction. Since endothelial function is thought to play a key role in coordinating tissue perfusion and modulating arterial compliance, improvement of endothelial dysfunction is imperative.
Objectives: We examined the improvement effect on endothelial dysfunction in patients with congestive heart failure associated with the dilated cardiomyopathy. We compared the change in the endothelial function following therapies between patients who were treated by medical therapy alone and by cardiac resynchronization therapy.
Methods: There were 11 patients who were treated by medical therapy (group 1, mean age; 61±10 years, 4 male) and 5 patients by cardiac resynchronization therapy (group 2, mean age 64±13 years, 3 male). Endothelial function was examined by the reactive hyperemia peripheral arterial tonometry (RH-PAT). In both groups, RH-PAT was measured before and after therapy for congestive heart failure.
Result: Following the medical therapy, the New York Heart Association (NYHA) level (2.7±0.3 vs. 1.5±0.2, p<0.001), end-diastolic left ventricular dimension (LVDd) (57.8±2.0 vs. 55.0±2.2, p=0.042), LV ejection fraction (LVEF) (29.5±1.3 vs. 39.2±3.0, p=0.015) and plasma brain natriuretic peptide (BNP) (530.9±168.7 vs. 174.2±41.1, p=0.026) were significantly improved in group 1. In group 2, there were significant improvement in the NYHA level (2.8±0.6 vs. 1.0±0.0, p=0.037), LVEF (21.1±1.1 vs. 30.0±1.8, p=0.017) and plasma BNP (669.4±161.7 vs. 214.2±22.7, p=0.038), but was not in the LVDd (67.0±0.9 vs. 61.6±1.8, p=0.097). Thus, the congestive heart failure was improved similarly in both group 1 and 2. However, there was a discrepancy in the change of the RH-PAT. Although the RH-PAT was not improved in group 1 following the medical therapy (1.57±0.11 vs. 1.57±0.12, p=NS), there was a significant improvement of the RH-PAT in group 2 following the cardiac resynchronization therapy (1.32±0.13 vs. 1.69±0.18, p=0.032).
Conclusions: Cardiac resynchronization therapy for the congestive heart failure effectively improves the endothelial function in patients with dilated cardiomyopathy, compared with the medical therapy alone.