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Prognostic Effect and Modulation of Cardiac Sympathetic Function in Heart Failure Patients Treated with Cardiac Resynchronization Therapy

2020Journal article Open access
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dc.contributor.authorIlhão Moreira, R
dc.contributor.authorAbreu, A
dc.contributor.authorPortugal, G
dc.contributor.authorOliveira, L
dc.contributor.authorOliveira, MM
dc.contributor.authorRodrigues, I
dc.contributor.authorCoutinho Cruz, M
dc.contributor.authorSilva Cunha, P
dc.contributor.authorSantos, V
dc.contributor.authorSanta Clara, H
dc.contributor.authorMota Carmo, M
dc.contributor.authorCruz Ferreira, R
dc.date.accessioned2021-09-07T15:23:49Z
dc.date.available2021-09-07T15:23:49Z
dc.date.issued2020
dc.description.abstractBackground: Cardiac autonomic dysfunction as assessed by 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy is associated with poor prognosis in heart failure (HF) patients. Although cardiac resynchronization therapy (CRT) has emerged as an effective therapy in improving outcomes on HF patients, its effect on cardiac sympathetic nervous function is still not fully understood. We aimed to study the value of pre-implantation 123I-mIBG late heart-to-mediastinum ratio (HMR) as a predictor of response and outcomes after CRT and to correlate modification in this parameter with CRT response and functional improvement. Methods and results: BETTER-HF (Benefit of exercise training therapy and cardiac resynchronization in HF patients) is a prospective randomized clinical trial including HF patients submitted CRT (mean LVEF 24 ± 8%, 74% NYHA class ≥ III) who underwent a clinical, echocardiographic, and scintigraphic assessment before and 6 months after CRT. One-hundred and twenty-one patients were included. Echocardiographic response was observed in 54% and composite outcome of cardiac mortality, cardiac transplant or heart failure hospitalization in 24% of patients. Baseline late HMR was an independent predictor of CRT response (regression coefficient 2.906, 95% CI 0.293-3.903, P .029) and outcomes (HR 0.066 95% CI 0.005-0.880, P .040). At follow-up, 123I-mIBG imaging showed positive changes in cardiac sympathetic nerve activity only in responders to CRT (1.36 ± 0.14 prior vs. 1.42 ± 0.16 after CRT, P .039). There was a significant correlation between improvement in late HMR and improvement in peak oxygen consumption (r 0.547, P < .001). Conclusion: In our study, baseline cardiac denervation predicted response and clinical outcomes after CRT implantation. Cardiac sympathetic function was improved only in patients who responded to CRT and these positive changes were correlated with improvement in functional capacity.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Nucl Cardiol. 2020 Feb;27(1):283-290.pt_PT
dc.identifier.doi10.1007/s12350-018-1357-x.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3841
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.subjectHSM CARpt_PT
dc.subjectAgedpt_PT
dc.subjectFemalept_PT
dc.subjectMalept_PT
dc.subjectHumanspt_PT
dc.subject3-Iodobenzylguanidinept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectCardiac Resynchronization Therapypt_PT
dc.subjectCohort Studiespt_PT
dc.subjectHeart Failure / diagnostic imagingpt_PT
dc.subjectHeart Failure / physiopathologypt_PT
dc.subjectHeart Failure / therapypt_PT
dc.subjectHeart Rate / physiologypt_PT
dc.subjectPrognosispt_PT
dc.subjectRadiopharmaceuticalspt_PT
dc.subjectTomography, Emission-Computed, Single-Photonpt_PT
dc.titlePrognostic Effect and Modulation of Cardiac Sympathetic Function in Heart Failure Patients Treated with Cardiac Resynchronization Therapypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage290pt_PT
oaire.citation.startPage283pt_PT
oaire.citation.titleJournal of Nuclear Cardiologypt_PT
oaire.citation.volume27pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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