Fingertip Reactive Hyperemia Peripheral Arterial Tonometry Score Predicts Response to Biventricular Pacing

Abstract

Purpose: The objectives of this study were to: (i) evaluate endothelial function via fingertip reactive hyperemia peripheral arterial tonometry (RH-PAT) among heart failure (HF) patients receiving cardiac resynchronization therapy (CRT), (ii) assess the effects of CRT on RH-PAT score, and (iii) investigate whether RH-PAT score can identify CRT response.

Methods: A total of 63 patients (61.8 ± 10.3 years; 50 males; left ventricular (LV) ejection fraction 24.3 ± 3.9%) with HF who received CRT were enrolled. Endothelial function via RH-PAT was assessed 1 day before and 6 months after CRT. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) was used to assess clinical improvements. CRT response was defined as a reduction in LV end-systolic volume ≥ 15% at 6 months.

Results: A RH-PAT score of < 1.7 signified a cut-off for endothelial dysfunction (ED). Baseline ED was observed among 43 (68.3%) patients and was more prevalent in responders (76.1% vs. 47.1%, p = 0.037). RH-PAT score improved 6 months after CRT (1.58 ± 0.35 vs. 1.71 ± 0.31, p = 0.012). A RH-PAT score of < 1.7 was a significant independent predictor of CRT response in multivariate logistic regression analysis (β = 1.275, OR = 3.512, 95% CI = 1.231-11.477, p = 0.032). The severity of ED was an independent predictor of LV reverse remodeling (β = -8.873, p = 0.015). Spearman's correlation analysis revealed moderate positive correlations between an improvement in RH-PAT (ΔRH-PAT) and LV reverse remodeling (r = 0.461, p = 0.001) and MLWHFQ score (r = 0.440, p = 0.001).

Conclusions: ED detected via RH-PAT could predict the response to CRT. The RH-PAT score increased 6 months after CRT and was correlated with echocardiographic and clinical improvements.

Keywords: Cardiac resynchronization therapy; Endothelial dysfunction; Heart failure; Peripheral arterial tonometry; Response.

Figure 1

Reactive hyperemia peripheral arterial tonometry measurement, (A) EndoPAT2000 device. (B) System and finger alignment were shown. On right side, an example of a HF patient with (C) endothelial dysfunction and (D) normal endothelial function were shown.

Figure 2

Changes in RH-PAT scores were shown. Error bars represents 95% confidence interval.

Figure 3

Spearman’s correlation analysis between percentage of improvement in RH-PAT score with (A) echocardiographic response, (B) clinical improvement after CRT. r, correlation coefficient.