Failure: A Prognostic Comparison

.., Background: Controlled clinical trials have shown the beneficial effects of biventricular pacing (BVP) in patients with heari failure (HF) and left bundle branch block. The effect of CRT on the hemodynamic response to exercise (ex) have not been studied, yet. Methods: Eighteen consecutive patients with chronic HF, QRS duration >150 msec and left ventricular ejection fraction (LVEF) < 35% were studied by MUGA and cardiopulmonary ax test with simultaneous Swan-Ganz cath, before and after 6 months of CRT with BVP. Aim: To investigate whether the effects of physical training (PT) on serum monocyterelated inflammatory markers such as tumor necrosis factor-a (TNF-a), granulcqie-macrophage colony-stimulating factor (GM-CSF), macrophage chemoanractant protein-l (MCP-I), soluble intercellular adhesion molecule-l @ICAM-1) and soluble vascular cell adhesion molecule-l (sVCAM-l), are associated with changes in peripheral blood flow and endothelial function of patients with chronic heart failure (CHF) Methods: Serum levels of these markers were assessed by ELISA in 15 CHF patients (ischemic:7, dilated:8, NYHA:II-III. EF:23t3%) before and after a 12.week program of PT in a randomlsed crossover design. Peak oxygen uptake (VOPmax) was used to estimate functional status of CHF patients and venous occlusion plethysmography to assess endothelial function through reactive hyperemia-induced vasodilatation. Results: PT produced a significant reduction I” TNF-a (7.2+1 .l vs 4.9eO.9 pgiml, pcO.Ol), GM-CSF (26.5+1.9 vs 20.&1.5 pg/ml, pcO.O2), MCP-1 (191+5 vs 175+5 pg/ml, pcO.OOl), slCAM-1 (385t29 vs 322i26 ng/ml, pcO.005) and sVCAMI1 (1309*98 vs 1121&g ng/ml, p

Keywords:

• Haemodynamic response
• Blood flow
• Crossover study
• Heart failure
• QRS complex
• VO2 max
• Ejection fraction
• Anesthesia
• Vasodilation
• Cardiology
• Internal medicine
• Medicine
• reactive hyperemia

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