PMID- 15381677
OWN - NLM
STAT- MEDLINE
DCOM- 20050421
LR  - 20160726
IS  - 1524-4563 (Electronic)
IS  - 0194-911X (Linking)
VI  - 44
IP  - 5
DP  - 2004 Nov
TI  - Sustained sympathoinhibitory effects of cardiac resynchronization therapy in 
      severe heart failure.
PG  - 727-31
AB  - Evidence is available that in heart failure, cardiac resynchronization therapy by 
      biventricular pacing improves myocardial function and exercise capacity. Whether 
      this is accompanied by a sustained inhibition of heart failure-dependent 
      sympathoexcitation is uncertain. In 11 heart failure patients (mean+/-SEM age, 
      68.4+/-1.5 years) in New York Heart Association (NYHA) class III and IV under 
      medical treatment with an intraventricular conduction delay (QRS duration > or 
      =130 ms), with a markedly depressed left ventricular ejection fraction, and 
      undergoing implantation of a biventricular pacemaker, we measured beat-to-beat 
      blood pressure and muscle sympathetic nerve traffic. Measurements, which also 
      included echocardiographic and clinical variables, were performed before and 
      approximately 10 weeks after successful resynchronization therapy. Ten age- and 
      NYHA class-matched heart failure patients who were under medical treatment for 
      the same time period served as controls. Long-term resynchronization therapy 
      improved cardiac function and caused a significant increase in systolic blood 
      pressure coupled with an improvement in maximal oxygen consumption and exercise 
      capacity. These effects were coupled with a significant and marked reduction in 
      sympathetic nerve traffic when expressed both as burst frequency over time 
      (44.1+/-3.6 vs 30.7+/-3.0 bs/min, -30.5%, P<0.02) and as burst frequency 
      corrected for heart rate (68.3+/-5.9 vs 47.3+/-4.3 bs/100 beats, -32.1%, P<0.02). 
      No significant change in the aforementioned parameters was seen in the control 
      group. These data provide the first direct evidence that in severe heart failure, 
      resynchronization therapy exerts a marked and sustained sympathoinhibition. 
      Because in heart failure sympathetic overactivity adversely affects prognosis, 
      this may have important clinical implications.
FAU - Grassi, Guido
AU  - Grassi G
AD  - Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie 
      Sanitarie, Universita Milano-Bicocca, Italy.
FAU - Vincenti, Antonio
AU  - Vincenti A
FAU - Brambilla, Roberta
AU  - Brambilla R
FAU - Trevano, Fosca Quarti
AU  - Trevano FQ
FAU - Dell'Oro, Raffaella
AU  - Dell'Oro R
FAU - Ciro, Antonio
AU  - Ciro A
FAU - Trocino, Giuseppe
AU  - Trocino G
FAU - Vincenzi, Antonella
AU  - Vincenzi A
FAU - Mancia, Giuseppe
AU  - Mancia G
LA  - eng
PT  - Journal Article
DEP - 20040920
PL  - United States
TA  - Hypertension
JT  - Hypertension (Dallas, Tex. : 1979)
JID - 7906255
SB  - IM
MH  - Aged
MH  - *Cardiac Pacing, Artificial
MH  - Heart Failure/*physiopathology/*therapy
MH  - Hemodynamics/*physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Sympathetic Nervous System/*physiology
EDAT- 2004/09/24 05:00
MHDA- 2005/04/22 09:00
CRDT- 2004/09/24 05:00
PHST- 2004/09/24 05:00 [pubmed]
PHST- 2005/04/22 09:00 [medline]
PHST- 2004/09/24 05:00 [entrez]
AID - 01.HYP.0000144271.59333.a7 [pii]
AID - 10.1161/01.HYP.0000144271.59333.a7 [doi]
PST - ppublish
SO  - Hypertension. 2004 Nov;44(5):727-31. doi: 10.1161/01.HYP.0000144271.59333.a7. 
      Epub 2004 Sep 20.