Cardiac resynchronization Therapy/methods

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Editorial

Measurement of PETCO2 at Anaerobic Threshold: A Best Prognostic Marker in Patients with Cardiac Resynchronization Therapy?

Anderson Donelli da Silveira et al. Maurício Pimentel

The cardiopulmonary exercise test (CPET) is a consolidated tool in the functional and prognostic assessment of patients with heart failure with reduced ejection fraction (HFrRF), being a cornerstone in the evaluation for the indication of advanced therapies in HFrEF.^, Cardiac resynchronization therapy (CRT), in addition to reducing mortality, can improve cardiorespiratory fitness, leading to an increase in peak oxygen consumption (VO₂peak) and a reduction in the slope of the respiratory equivalent CO2 ratio (VE /VCO2 slope).^– In recent years, with the evolution of treatments, general mortality and the risk of the sudden death of patients with HFpEF have been reduced.^, In this context, reviewing the prognosis and the values associated with a higher risk among the CPET variables in patients undergoing CRT becomes important.

The measurement of end-tidal carbon dioxide pressure (PETCO2) during CPET, both at rest, and at the first ventilatory threshold or anaerobic threshold (P_ETCO2_LA), has a well-established prognostic value in heart failure.^, The increase of dead space ventilation, caused by the impairment of the ventilation/perfusion (V/Q) ratio, for example, in patients with left ventricular dysfunction, leads to a reduction in alveolar CO2 and, consequently, in P_ETCO₂. It is expected that there will be an increase in its measurement up to the anaerobic threshold, which is correlated with an increase in cardiac output.

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Original Article

Predictive Ability of Cardiopulmonary Exercise Test Parameters in Heart Failure Patients with Cardiac Resynchronization Therapy

João Ferreira Reis et al. António Valentim Gonçalves Pedro Garcia Brás Rita Ilhão Moreira … Pedro Rio Ana Teresa Timóteo Rui M. Soares Rui Cruz Ferreira

Abstract

Background

There is evidence suggesting that a peak oxygen uptake (pVO₂) cut-off of 10ml/kg/min provides a more precise risk stratification in cardiac resynchronization therapy (CRT) patients.

Objective

To compare the prognostic power of several cardiopulmonary exercise testing (CPET) parameters in this population and assess the discriminative ability of the guideline-recommended pVO₂cut-off values.

Methods

Prospective evaluation of consecutive heart failure (HF) patients with left ventricular ejection fraction ≤40%. The primary endpoint was a composite of cardiac death and urgent heart transplantation (HT) in the first 24 follow-up months, and was analysed by several CPET parameters for the highest area under the curve (AUC) in the CRT group. A survival analysis was performed to evaluate the risk stratification provided by several different cut-offs. p values <0.05 were considered significant.

Results

A total of 450 HF patients, of which 114 had a CRT device. These patients had a higher baseline risk profile, but there was no difference regarding the primary outcome (13.2% vs 11.6%, p =0.660). End-tidal carbon dioxide pressure at anaerobic threshold (P_ETCO_2AT)had the highest AUC value, which was significantly higher than that of pVO₂in the CRT group (0.951 vs 0.778, p =0.046). The currently recommended pVO₂cut-off provided accurate risk stratification in this setting (p <0.001), and the suggested cut-off value of 10 ml/min/kg did not improve risk discrimination in device patients (p =0.772).

Conclusion

P_ETCO_2ATmay outperform pVO₂’s prognostic power for adverse events in CRT patients. The current guideline-recommended pVO2 cut-off can precisely risk-stratify this population.

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Letter to the Editor

Prolonged PR Interval and Outcome in Cardiac Resynchronization Therapy

Jakrin Kewcharoen et al. Chanavuth Kanitsoraphan

Dear Editor

We read the article “Baseline Prolonged PR Interval and Outcome of Cardiac Resynchronization Therapy: A Systematic Review and Meta-analysis” by Rattanawong et al. with great interest. The authors investigated the effect of prolonged PR interval on composite outcome among patients who received cardio resynchronized therapy. The authors conclude that prolonged PR is associated with worse outcome in this population.

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Measurement of PETCO2 at Anaerobic Threshold: A Best Prognostic Marker in Patients with Cardiac Resynchronization Therapy?

Predictive Ability of Cardiopulmonary Exercise Test Parameters in Heart Failure Patients with Cardiac Resynchronization Therapy

Abstract

Background

Objective

Methods

Results

Conclusion

Prolonged PR Interval and Outcome in Cardiac Resynchronization Therapy

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