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Impact of oxygen uptake efficiency slope as a marker of cardiorespiratory reserve on response to cardiac resynchronization therapy

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Abstract

Background

Cardiac resynchronization therapy (CRT) is limited by the high numbers of nonresponders. This study analyzed the impact of the cardiorespiratory functional reserve to predict the response to CRT.

Methods and results

Twenty-eight patients (age 67 ± 9 years, LVEF < 35%, NYHA class III, QRS 158 ± 25 ms) underwent submaximal cardiopulmonary treadmill exercise testing prior and 6 months after implantation of a CRT device. Breath-to-breath gas analysis was used for calculation of the oxygen uptake efficiency slope (OUES = non-effort-dependent index of cardiorespiratory functional reserve) in the responder and nonresponder group. Responders to CRT [defined by a decrease in left ventricular end-systolic volume (LVESV) > 15%] showed a significant lower cardiorespiratory reserve at baseline (prior CRT) as compared to the nonresponders (OUES 1,235 ± 651 vs. 2,480 ± 590; p < 0.01). Responders showed an increase in OUES during CRT at the 6 months follow-up (1,879 ± 663; p < 0.05) whereas nonresponders showed no significant changes from baseline (2,194 ± 422; ns). Both responders and nonresponders showed an improvement in LVEF at the 6 months follow-up (23 ± 5 vs. 31 ± 9% and 26 ± 7 vs. 32 ± 3%; p < 0.05). Responders to CRT showed a decrease in NYHA classification (3.0 vs. 2.6 ± 0.5; p < 0.05) and a decrease in LVESV (175 ± 58 vs. 128 ± 40 ml; p < 0.05).

Conclusions

Nonresponders to CRT showed a more preserved cardiorespiratory functional reserve as compared to responders despite similar NYHA classification. Evaluation of the OUES by submaximal exercise testing improves identification of responders to CRT.

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Acknowledgments

We are particularly indebted to Dr. Reizo Baba from the Tokai University School of Physical Education for his help according the calculation of the OUES. Moreover, we would like to thank Helmut Hoertnagl, Fritz Kuehndl and Herbert Sailer (Institute of Sports Medicine, University Hospital Innsbruck) for their valuable help according exercise testing.

Conflict of interest

The manuscript or part of it has not been published elsewhere. The author has no financial or other relations that could lead to a conflict of interest. T.B. has received a fellowship grant from the European Heart Rhythm Association (EHRA).

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine III, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Thomas Berger, Markus Stuehlinger, Wolfgang Dichtl, Gerhard Poelzl, Otmar Pachinger & Florian Hintringer

  2. Department of Respiratory and Critical Care Medicine, Otto-Wagner-Hospital, Vienna, Austria

    Ralf Harun Zwick

  3. Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria

    Michael Edlinger

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  1. Thomas Berger
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Correspondence to Thomas Berger.

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Berger, T., Zwick, R.H., Stuehlinger, M. et al. Impact of oxygen uptake efficiency slope as a marker of cardiorespiratory reserve on response to cardiac resynchronization therapy. Clin Res Cardiol 100, 159–166 (2011). https://doi.org/10.1007/s00392-010-0226-7

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  • DOI: https://doi.org/10.1007/s00392-010-0226-7

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