Ventilatory gas exchange and early response to cardiac resynchronization therapy

Chul Ho Kim, Lyle J. Olson, Win K. Shen, Yong-Mei Cha, Bruce David Johnson

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Cardiac resynchronization therapy (CRT) is an accepted intervention for chronic heart failure (HF), although approximately 30% of patients are non-responders. The purpose of this study was to determine whether exercise respiratory gas exchange obtained before CRT implantation predicts early response to CRT. Methods: Before CRT implantation, patients were assigned to either a mild-moderate group (Mod G, n = 33, age 67 ± 10 years) or a moderate-severe group (Sev G, n = 31, age 67 ± 10 years), based on abnormalities in exercise gas exchange. Severity of impaired gas exchange was based on a score from the measures of VE/VCO<inf>2</inf> slope, resting PETCO<inf>2</inf> and change of PETCO<inf>2</inf> from resting to peak. All measurements were performed before and 3 to 4 months after CRT implantation. Results: Although Mod G did not have improved gas exchange (p > 0.05), Sev G improved significantly (p < 0.05) post-CRT. In addition, Mod G did not show improved right ventricular systolic pressure (RSVP; pre vs post: 37 ± 14 vs 36 ± 11 mm Hg, p > 0.05), yet Sev G showed significantly improved RVSP, by 23% (50 ± 14 vs 42 ± 12 mm Hg, p < 0.05). Both groups had improved left ventricular ejection fraction (p < 0.05), New York Heart Association class (p < 0.05) and quality of life (p < 0.05), but no significant differences were observed between groups (p > 0.05). No significant changes were observed in brain natriuretic peptide in either group post-CRT. Conclusion: Based on pre-CRT implantation ventilatory gas exchange, subjects with the most impaired values appeared to have more improvement post-CRT, possibly associated with a decrease in RVSP.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - 2015

Fingerprint

Cardiac Resynchronization Therapy
Gases
Exercise
Brain Natriuretic Peptide
Heart Failure

Keywords

  • Exercise
  • Heart failure
  • Pulmonary hypertension
  • Right ventricle pressure
  • Ventilatory efficiency

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Ventilatory gas exchange and early response to cardiac resynchronization therapy. / Kim, Chul Ho; Olson, Lyle J.; Shen, Win K.; Cha, Yong-Mei; Johnson, Bruce David.

In: Journal of Heart and Lung Transplantation, 2015.

Research output: Contribution to journalArticle

@article{501db218ae2a4eb88f833acf956ab544,
title = "Ventilatory gas exchange and early response to cardiac resynchronization therapy",
abstract = "Background: Cardiac resynchronization therapy (CRT) is an accepted intervention for chronic heart failure (HF), although approximately 30{\%} of patients are non-responders. The purpose of this study was to determine whether exercise respiratory gas exchange obtained before CRT implantation predicts early response to CRT. Methods: Before CRT implantation, patients were assigned to either a mild-moderate group (Mod G, n = 33, age 67 ± 10 years) or a moderate-severe group (Sev G, n = 31, age 67 ± 10 years), based on abnormalities in exercise gas exchange. Severity of impaired gas exchange was based on a score from the measures of VE/VCO2 slope, resting PETCO2 and change of PETCO2 from resting to peak. All measurements were performed before and 3 to 4 months after CRT implantation. Results: Although Mod G did not have improved gas exchange (p > 0.05), Sev G improved significantly (p < 0.05) post-CRT. In addition, Mod G did not show improved right ventricular systolic pressure (RSVP; pre vs post: 37 ± 14 vs 36 ± 11 mm Hg, p > 0.05), yet Sev G showed significantly improved RVSP, by 23{\%} (50 ± 14 vs 42 ± 12 mm Hg, p < 0.05). Both groups had improved left ventricular ejection fraction (p < 0.05), New York Heart Association class (p < 0.05) and quality of life (p < 0.05), but no significant differences were observed between groups (p > 0.05). No significant changes were observed in brain natriuretic peptide in either group post-CRT. Conclusion: Based on pre-CRT implantation ventilatory gas exchange, subjects with the most impaired values appeared to have more improvement post-CRT, possibly associated with a decrease in RVSP.",
keywords = "Exercise, Heart failure, Pulmonary hypertension, Right ventricle pressure, Ventilatory efficiency",
author = "Kim, {Chul Ho} and Olson, {Lyle J.} and Shen, {Win K.} and Yong-Mei Cha and Johnson, {Bruce David}",
year = "2015",
doi = "10.1016/j.healun.2015.05.016",
language = "English (US)",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Ventilatory gas exchange and early response to cardiac resynchronization therapy

AU - Kim, Chul Ho

AU - Olson, Lyle J.

AU - Shen, Win K.

AU - Cha, Yong-Mei

AU - Johnson, Bruce David

PY - 2015

Y1 - 2015

N2 - Background: Cardiac resynchronization therapy (CRT) is an accepted intervention for chronic heart failure (HF), although approximately 30% of patients are non-responders. The purpose of this study was to determine whether exercise respiratory gas exchange obtained before CRT implantation predicts early response to CRT. Methods: Before CRT implantation, patients were assigned to either a mild-moderate group (Mod G, n = 33, age 67 ± 10 years) or a moderate-severe group (Sev G, n = 31, age 67 ± 10 years), based on abnormalities in exercise gas exchange. Severity of impaired gas exchange was based on a score from the measures of VE/VCO2 slope, resting PETCO2 and change of PETCO2 from resting to peak. All measurements were performed before and 3 to 4 months after CRT implantation. Results: Although Mod G did not have improved gas exchange (p > 0.05), Sev G improved significantly (p < 0.05) post-CRT. In addition, Mod G did not show improved right ventricular systolic pressure (RSVP; pre vs post: 37 ± 14 vs 36 ± 11 mm Hg, p > 0.05), yet Sev G showed significantly improved RVSP, by 23% (50 ± 14 vs 42 ± 12 mm Hg, p < 0.05). Both groups had improved left ventricular ejection fraction (p < 0.05), New York Heart Association class (p < 0.05) and quality of life (p < 0.05), but no significant differences were observed between groups (p > 0.05). No significant changes were observed in brain natriuretic peptide in either group post-CRT. Conclusion: Based on pre-CRT implantation ventilatory gas exchange, subjects with the most impaired values appeared to have more improvement post-CRT, possibly associated with a decrease in RVSP.

AB - Background: Cardiac resynchronization therapy (CRT) is an accepted intervention for chronic heart failure (HF), although approximately 30% of patients are non-responders. The purpose of this study was to determine whether exercise respiratory gas exchange obtained before CRT implantation predicts early response to CRT. Methods: Before CRT implantation, patients were assigned to either a mild-moderate group (Mod G, n = 33, age 67 ± 10 years) or a moderate-severe group (Sev G, n = 31, age 67 ± 10 years), based on abnormalities in exercise gas exchange. Severity of impaired gas exchange was based on a score from the measures of VE/VCO2 slope, resting PETCO2 and change of PETCO2 from resting to peak. All measurements were performed before and 3 to 4 months after CRT implantation. Results: Although Mod G did not have improved gas exchange (p > 0.05), Sev G improved significantly (p < 0.05) post-CRT. In addition, Mod G did not show improved right ventricular systolic pressure (RSVP; pre vs post: 37 ± 14 vs 36 ± 11 mm Hg, p > 0.05), yet Sev G showed significantly improved RVSP, by 23% (50 ± 14 vs 42 ± 12 mm Hg, p < 0.05). Both groups had improved left ventricular ejection fraction (p < 0.05), New York Heart Association class (p < 0.05) and quality of life (p < 0.05), but no significant differences were observed between groups (p > 0.05). No significant changes were observed in brain natriuretic peptide in either group post-CRT. Conclusion: Based on pre-CRT implantation ventilatory gas exchange, subjects with the most impaired values appeared to have more improvement post-CRT, possibly associated with a decrease in RVSP.

KW - Exercise

KW - Heart failure

KW - Pulmonary hypertension

KW - Right ventricle pressure

KW - Ventilatory efficiency

UR - http://www.scopus.com/inward/record.url?scp=84936094154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84936094154&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2015.05.016

DO - 10.1016/j.healun.2015.05.016

M3 - Article

C2 - 26163155

AN - SCOPUS:84946482834

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

ER -