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(Circulation. 2004;110:646-651.)
© 2004 American Heart Association, Inc.

Original Articles

Effects of Cardiac Resynchronization Therapy on Myocardial Perfusion Reserve

Paul Knaapen, MD; Linda (C.)M.C. van Campen, MD; Carel C. de Cock, MD, PhD; Marco J.W. Götte, MD, PhD; Cees A. Visser, MD, PhD; Adriaan A. Lammertsma, PhD; Frans C. Visser, MD, PhD

From the Departments of Cardiology (P.K., L.C.M.C.v.C., C.C.d.C., M.J.W.G., C.A.V., F.C.V.) and Nuclear Medicine and PET Research (A.A.L.), VU University Medical Center, Amsterdam, the Netherlands.

Correspondence to P. Knaapen, MD, Department of Cardiology, 6D Room 120, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. E-mail p.knaapen{at}vumc.nl

Received February 11, 2004; de novo received March 29, 2004; accepted May 4, 2004.

Background— Cardiac resynchronization therapy (CRT) is a relatively new treatment strategy for patients with heart failure and mechanical asynchrony. Reported effects of CRT on regional myocardial blood flow (MBF) are conflicting, and effects on hyperemic MBF are scarce. The aim of the present study was to assess serial changes of MBF and MBF reserve in patients receiving a biventricular pacemaker.

Methods and Results— Fourteen patients with heart failure (NYHA class III or IV; left ventricular ejection fraction <35%), QRS width >120 ms, and sinus rhythm were studied (mean age, 58±10 years; 8 men). MBF and hyperemic MBF were measured at baseline, 3 months after biventricular pacing (CRT on), and after cessation of pacing (CRT off) with PET and H₂¹⁵O. CRT had no significant effect on resting MBF (baseline versus CRT on versus CRT off: 0.82±0.25 versus 0.69±0.24 versus 0.74±0.24 mL · min^–1 · mL^–1; P=NS). Hyperemic MBF increased during CRT (1.91±1.03 versus 2.66±1.66 versus 1.92±1.06 mL · min^–1 · mL^–1; P=0.01 by MANOVA), as did MBF reserve (2.25±1.00 versus 3.76±2.38 versus 2.49±0.94 mL · min^–1 · mL^–1; P=0.023). CRT (reversibly) resulted in a more homogeneous distribution of regional resting MBF as demonstrated by the septal-to-lateral ratio. The decrease in the ratio of left ventricular end-diastolic volume to left ventricular mass, as a reflection of wall stress, was related to the increase in hyperemic MBF (r=0.53, P<0.05). Left ventricular ejection fraction increased from 25±7% to 37±9% (P<0.01).

Conclusions— Resting MBF is unaltered by CRT despite an increase in left ventricular function. However, the distribution pattern of resting MBF becomes more homogeneous. Hyperemic MBF and consequently MBF reserve are enhanced by CRT.

Key Words: blood flow • heart failure • pacing • tomography, emission-computed

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