Biventricular pacemaker therapy improves exercise capacity in patients with non-obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise

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Biventricular pacemaker therapy improves exercise capacity in patients with non-obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise. / Ahmed, Ibrar; Loudon, Brodie L; Abozguia, Khalid; Cameron, Donnie; Shivu, Ganesh N; Phan, Thanh T; Maher, Abdul; Stegemann, Berthold; Chow, Anthony; Marshall, Howard; Nightingale, Peter; Leyva, Francisco; Vassiliou, Vassilios S; McKenna, William J; Elliott, Perry; Frenneaux, Michael P.

In: European Journal of Heart Failure, 23.01.2020.

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Ahmed, Ibrar ; Loudon, Brodie L ; Abozguia, Khalid ; Cameron, Donnie ; Shivu, Ganesh N ; Phan, Thanh T ; Maher, Abdul ; Stegemann, Berthold ; Chow, Anthony ; Marshall, Howard ; Nightingale, Peter ; Leyva, Francisco ; Vassiliou, Vassilios S ; McKenna, William J ; Elliott, Perry ; Frenneaux, Michael P. / Biventricular pacemaker therapy improves exercise capacity in patients with non-obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise. In: European Journal of Heart Failure. 2020.

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@article{dfbe514df4804d52b20ee064bd6c247b,
title = "Biventricular pacemaker therapy improves exercise capacity in patients with non-obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise",
abstract = "AIMS: Treatment options for patients with non-obstructive hypertrophic cardiomyopathy (HCM) are limited. We sought to determine whether biventricular (BiV) pacing improves exercise capacity in HCM patients, and whether this is via augmented diastolic filling.METHODS AND RESULTS: Thirty-one patients with symptomatic non-obstructive HCM were enrolled. Following device implantation, patients underwent detailed assessment of exercise diastolic filling using radionuclide ventriculography in BiV and sham pacing modes. Patients then entered an 8-month crossover study of BiV and sham pacing in random order, to assess the effect on exercise capacity [peak oxygen consumption (VO2 )]. Patients were grouped on pre-specified analysis according to whether left ventricular end-diastolic volume increased (+LVEDV) or was unchanged/decreased (-LVEDV) with exercise at baseline. Twenty-nine patients (20 male, mean age 55 years) completed the study. There were 14 +LVEDV patients and 15 -LVEDV patients. Baseline peak VO2 was lower in -LVEDV patients vs. +LVEDV patients (16.2 ± 0.9 vs. 19.9 ± 1.1 mL/kg/min, P = 0.04). BiV pacing significantly increased exercise ΔLVEDV (P = 0.004) and Δstroke volume (P = 0.008) in -LVEDV patients, but not in +LVEDV patients. Left ventricular ejection fraction and end-systolic elastance did not increase with BiV pacing in either group. This translated into significantly greater improvements in exercise capacity (peak VO2  + 1.4 mL/kg/min, P = 0.03) and quality of life scores (P = 0.02) in -LVEDV patients during the crossover study. There was no effect on left ventricular mechanical dyssynchrony in either group.CONCLUSION: Symptomatic patients with non-obstructive HCM may benefit from BiV pacing via augmentation of diastolic filling on exercise rather than contractile improvement. This may be due to relief of diastolic ventricular interaction.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00504647.",
keywords = "Hypertrophic cardiomyopathy, Biventricular pacemaker therapy, Diastolic ventricular interaction",
author = "Ibrar Ahmed and Loudon, {Brodie L} and Khalid Abozguia and Donnie Cameron and Shivu, {Ganesh N} and Phan, {Thanh T} and Abdul Maher and Berthold Stegemann and Anthony Chow and Howard Marshall and Peter Nightingale and Francisco Leyva and Vassiliou, {Vassilios S} and McKenna, {William J} and Perry Elliott and Frenneaux, {Michael P}",
note = "{\textcopyright} 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.",
year = "2020",
month = jan,
day = "23",
doi = "10.1002/ejhf.1722",
language = "English",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",

}

RIS

TY - JOUR

T1 - Biventricular pacemaker therapy improves exercise capacity in patients with non-obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise

AU - Ahmed, Ibrar

AU - Loudon, Brodie L

AU - Abozguia, Khalid

AU - Cameron, Donnie

AU - Shivu, Ganesh N

AU - Phan, Thanh T

AU - Maher, Abdul

AU - Stegemann, Berthold

AU - Chow, Anthony

AU - Marshall, Howard

AU - Nightingale, Peter

AU - Leyva, Francisco

AU - Vassiliou, Vassilios S

AU - McKenna, William J

AU - Elliott, Perry

AU - Frenneaux, Michael P

N1 - © 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PY - 2020/1/23

Y1 - 2020/1/23

N2 - AIMS: Treatment options for patients with non-obstructive hypertrophic cardiomyopathy (HCM) are limited. We sought to determine whether biventricular (BiV) pacing improves exercise capacity in HCM patients, and whether this is via augmented diastolic filling.METHODS AND RESULTS: Thirty-one patients with symptomatic non-obstructive HCM were enrolled. Following device implantation, patients underwent detailed assessment of exercise diastolic filling using radionuclide ventriculography in BiV and sham pacing modes. Patients then entered an 8-month crossover study of BiV and sham pacing in random order, to assess the effect on exercise capacity [peak oxygen consumption (VO2 )]. Patients were grouped on pre-specified analysis according to whether left ventricular end-diastolic volume increased (+LVEDV) or was unchanged/decreased (-LVEDV) with exercise at baseline. Twenty-nine patients (20 male, mean age 55 years) completed the study. There were 14 +LVEDV patients and 15 -LVEDV patients. Baseline peak VO2 was lower in -LVEDV patients vs. +LVEDV patients (16.2 ± 0.9 vs. 19.9 ± 1.1 mL/kg/min, P = 0.04). BiV pacing significantly increased exercise ΔLVEDV (P = 0.004) and Δstroke volume (P = 0.008) in -LVEDV patients, but not in +LVEDV patients. Left ventricular ejection fraction and end-systolic elastance did not increase with BiV pacing in either group. This translated into significantly greater improvements in exercise capacity (peak VO2  + 1.4 mL/kg/min, P = 0.03) and quality of life scores (P = 0.02) in -LVEDV patients during the crossover study. There was no effect on left ventricular mechanical dyssynchrony in either group.CONCLUSION: Symptomatic patients with non-obstructive HCM may benefit from BiV pacing via augmentation of diastolic filling on exercise rather than contractile improvement. This may be due to relief of diastolic ventricular interaction.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00504647.

AB - AIMS: Treatment options for patients with non-obstructive hypertrophic cardiomyopathy (HCM) are limited. We sought to determine whether biventricular (BiV) pacing improves exercise capacity in HCM patients, and whether this is via augmented diastolic filling.METHODS AND RESULTS: Thirty-one patients with symptomatic non-obstructive HCM were enrolled. Following device implantation, patients underwent detailed assessment of exercise diastolic filling using radionuclide ventriculography in BiV and sham pacing modes. Patients then entered an 8-month crossover study of BiV and sham pacing in random order, to assess the effect on exercise capacity [peak oxygen consumption (VO2 )]. Patients were grouped on pre-specified analysis according to whether left ventricular end-diastolic volume increased (+LVEDV) or was unchanged/decreased (-LVEDV) with exercise at baseline. Twenty-nine patients (20 male, mean age 55 years) completed the study. There were 14 +LVEDV patients and 15 -LVEDV patients. Baseline peak VO2 was lower in -LVEDV patients vs. +LVEDV patients (16.2 ± 0.9 vs. 19.9 ± 1.1 mL/kg/min, P = 0.04). BiV pacing significantly increased exercise ΔLVEDV (P = 0.004) and Δstroke volume (P = 0.008) in -LVEDV patients, but not in +LVEDV patients. Left ventricular ejection fraction and end-systolic elastance did not increase with BiV pacing in either group. This translated into significantly greater improvements in exercise capacity (peak VO2  + 1.4 mL/kg/min, P = 0.03) and quality of life scores (P = 0.02) in -LVEDV patients during the crossover study. There was no effect on left ventricular mechanical dyssynchrony in either group.CONCLUSION: Symptomatic patients with non-obstructive HCM may benefit from BiV pacing via augmentation of diastolic filling on exercise rather than contractile improvement. This may be due to relief of diastolic ventricular interaction.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00504647.

KW - Hypertrophic cardiomyopathy

KW - Biventricular pacemaker therapy

KW - Diastolic ventricular interaction

U2 - 10.1002/ejhf.1722

DO - 10.1002/ejhf.1722

M3 - Article

C2 - 31975494

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

ER -