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Pacing from a Novel Quadripolar LV Lead Improves LV Synchrony in CRT Patients
The 15th Annual Scientific Meeting
S9
HFSA
leg press was used to assess muscle strength: max strength (1RM), maximal power (1RM power), and endurance (60%RM power). Results: FM was similar in both groups, yet HF patients had reduced aerobic indices (peak VO2 [15.43643 vs. 23.8565.5 ml/kg/min p!0.0001], VAT [10.5462.7 vs. 14.4963.7 ml/kg/min p! 0.0001], and VE/VCO2 slope [37.07613.0 vs. 29.0464.9 p!0.02]) and strength indices (1RM [155.5657.6 vs. 191659.4kg p!0.04] and 60%RM power [4546207.5 vs. 602.46268.1 p!0.04]). As indicated in the Table, FM did not correlate to aerobic indices in HF, but correlated significantly to strength parameters with generally stronger associations in HF than controls.
Correlations Total Fat Aerobic Variables Peak VO2 VAT VE/VCO2 Strength Variables 1RM 1RM power 60%RM power
HF 0.06 0.06 0.20 0.64** 0.57** 0.26
Control 0.44* 0.25 0.05 0.45* 0.01 0.03
Legs Fat HF 0.10 0.09 0.17 0.52* 0.48* 0.03
Control 0.16 0.02 0.27 0.23 0.07 0.20
Arms Fat HF 0.16 0.13 0.16 0.45* 0.40 0.26
Control 0.39* 0.23 0.03 0.44* 0.02 0.20
* p!0.05, **p!0.01, ***p!0.001
023 Obese Patients with Equivalent NYHA Have Less Cardiac Impairment Than Non-Obese Counterparts Shanmugakumar Chinnappa1, Nigel Lewis1, David Goldspink2, Diane Barker1, Lip-Bun Tan1; 1Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 2 University of Leeds, Leeds, United Kingdom Background: The management of obese heart failure (HF) patients has been confounded by evidence that their prognosis is better and their BNP levels lower than their non-obese counterparts. We set out to characterise the cardiac and physical functional reserves of obese HF patients and compare with those of non-obese counterparts and healthy controls. Methods: We studied male heart failure patients in NYHA classes II and III and compared their physical and cardiac functional reserves between those with BMI O34 kg/m2 (O) and BMI #30 (NonO). We assessed them relative to healthy male volunteers (C, n5101) with no known cardiovascular diseases spanning the entire adult age range (19-76 years) with BMI 25.45 60.33, who served as control subjects. They underwent weight-bearing treadmill exercise testing with standard respiratory gas analyses and non-invasive haemodynamics including rebreathing method of measuring cardiac outputs during peak exercise. Results: The HF patients consisted of 24 obese (O, BMI 44.966.8) and 30 non-obese (NonO, BMI 25.062.9) patients with similar mean age (O: 4968(SD), NonO: 49615 years), and similar NYHA functional classes (O: 2.5060.50; NonO: 2.4860.51). The obese had lower peak O2 uptake per kg body weight (O: 18.464.2 vs NonO: 20.563.7 ml/min/kg, p!0.01). However, the obese HF patients had significantly higher aerobic exercise capacity (O: 2.57560.748 vs NonO: 1.59460.325 L/min, p!10 6), associated with significantly higher cardiac pumping capability (peak cardiac power output of 4.561.6 W (O) vs 2.460.6 W (NonO), p! 10 6). On average the obese HF patients had aerobic capacity equivalent to 91.6623.4% of healthy controls and cardiac reserve of 85.8628.1% of controls, whereas their non-obese counterparts had significantly lower values with 58.9614.6% and 46.1611.1% respectively (all p!10 6). Conclusion: These results showed that despite similar mean age and NYHA functional classes, the obese HF patients had significantly less impairment in their cardiac functional reserve than their non-obese counterparts, suggesting a crucial discrepancy between subjective impressions and objective evaluation of HF severity in obese HF patients.
024 Fat Measurement and Functional Characteristics in Heart Failure Patients A. Zavin1, K. Allsup1, D.R. Gagnon6,7, R. Arena4, S. Davis1, J. Joseph1,2, S. Lecker2, A. Lazzari1,3, P.C. Schulze5, D.E. Forman1,2; 1VA Boston Healthcare System, Boston, MA; 2Harvard Medical School, Boston, MA; 3Boston University School of Medicine, Boston, MA; 4University of New Mexico, Albuquerque, NM; 5Columbia University Medical Center, New York, NY; 6Boston University SPH, Boston, MA; 7VA Cooperative Studies Program, Boston, MA Introduction: Prior studies indicate that increased exercise capacity corresponds to improved prognosis in a HF population. Past work also indicates that increased adipose tissue (based on body mass index [BMI]) corresponds to improved prognosis. To better understand the cardioprotective benefits of adiposity, dual-energy x-ray absorptiometry (DXA) was used to characterize fat mass (FM) in relation to functional capacity (aerobic and strength) in HF. Hypothesis: Increased FM corresponds to functional benefits in HF patients. Methods: 51 men were studied (mean age 66.9610 years), 20 euvolemic, systolic HF patients (LVEF#40%) and 31 healthy controls. DXA was used to assess FM (total and appendicular [legs and arms]). CPX was used to assess aerobic indices: peak oxygen consumption (VO2), VO2 at anaerobic threshold (VAT), and ventilatory efficiency (VE/VCO2 slope). A pneumatic
Conclusion: Adiposity may stimulate increased strength capacities in HF patients, an effect that helps explain the paradoxical mortality benefits with which adiposity is also attributed. Further research regarding the paradoxical health benefits of adiposity in HF is still needed.
025 Pacing from a Novel Quadripolar LV Lead Improves LV Synchrony in CRT Patients Gery F. Tomassoni1, Melody Muir1, Erin O’Brien2, Kyungmoo Ryu2, Aaron Hesselson1; 1Lexington Cardiology Consultants, Lexington, KY; 2St. Jude Medical, Sylmar, CA LV circumferential strain analysis using Velocity Vector Imaging (VVI) has been used to assess acute response to CRT. Recently, a new quadripolar LV lead (Quartet, St. Jude Medical) with 10 different pacing vectors (VectSelect: 3 conventional [ConV], 7 unconventional [NConV]) has been developed to improve CRT response by providing more pacing options for CRT programming. We report our initial experience using VVI to assess the LV strain response with the Quartet post CRT implant. Methods: Eight male ischemic patients (7168 yrs old, LV EF 2765%) with LBBB (QRSd 154621 ms) and persistent Class III CHF underwent CRT implant with the Quartet LV lead. The lead location was mid-distal posterolateral or lateral in all patients. Real-time 6 segment LV circumferential tissue strain analysis using VVI software (Siemens) was performed during pacing from each of all 10 pacing vectors at 2X the capture voltage at 24 hrs discharge (n58), 3 (n56), 6 (n55), and 12 (n51) months post implant. In addition, strain analysis was performed at 3, 6, and 12 months post implant during high output pacing (7.5V/1 ms) at each of 10 pacing vectors. AV interval remained constant for all pacing interventions at each visit for each patient. A 6 segment time-to-peak strain of opposing LV segments O130 ms was defined as dyssynchrony. Results: Resynchronization was achieved in all patients at each visit by pacing from at least one pacing vector. If ConV were used only, LV resynchronization would not have occurred in 3 patients (38%) during 12 months post implant. ConV resynchronized the LV in 29/60 (48%) vs. NConV in 65/131 (50%). 28/73 (38%), 35/59 (59%), 29/48 (60%), and 7/10 (70%) pacing vectors demonstrated resynchronization at 24 hrs, 3, 6, and 12 months respectively. Pacing with NConV resulted in the greatest reduction in dyssynchrony in 63%, 83%, 80%, and 100% of the patients at 24 hrs, 3, 6, and 12 months, respectively. High output pacing resulted in 41/88 (47%) pacing vectors with resynchronization. When a dyssynchronous pattern was present at certain pacing vectors, high output pacing resynchronized the LV in 17/43 (40%). Conclusions: The Quartet LV lead along with CRT device equipped with a VectSelect feature adds 7 NConV vectors which can increase the chance of LV resynchronization. In addition, the percentage of pacing vectors that resynchronize the LV appears to increase at 3, 6, and 12 months post implant. Finally, high output pacing can resynchronize a LV dyssynchronous pattern in 40% of the time.
026 Hematological Malignancies Are Associated with Significant Elevations in N-Terminal Pro Brain Natriuretic Peptide Jesal Popat, Abel Rivero, Maya Guglin; Department of Cardiovascular Medicine, University of South Florida, Tampa, FL Background: It has previously been stated that cancer patients frequently have marked elevations in brain natriuretic peptide (BNP) levels. This finding has been more commonly observed in patients with solid tumors compared to those with hematologic malignancies. Furthermore, the degree of elevation does not always appear
S9
HFSA
leg press was used to assess muscle strength: max strength (1RM), maximal power (1RM power), and endurance (60%RM power). Results: FM was similar in both groups, yet HF patients had reduced aerobic indices (peak VO2 [15.43643 vs. 23.8565.5 ml/kg/min p!0.0001], VAT [10.5462.7 vs. 14.4963.7 ml/kg/min p! 0.0001], and VE/VCO2 slope [37.07613.0 vs. 29.0464.9 p!0.02]) and strength indices (1RM [155.5657.6 vs. 191659.4kg p!0.04] and 60%RM power [4546207.5 vs. 602.46268.1 p!0.04]). As indicated in the Table, FM did not correlate to aerobic indices in HF, but correlated significantly to strength parameters with generally stronger associations in HF than controls.
Correlations Total Fat Aerobic Variables Peak VO2 VAT VE/VCO2 Strength Variables 1RM 1RM power 60%RM power
HF 0.06 0.06 0.20 0.64** 0.57** 0.26
Control 0.44* 0.25 0.05 0.45* 0.01 0.03
Legs Fat HF 0.10 0.09 0.17 0.52* 0.48* 0.03
Control 0.16 0.02 0.27 0.23 0.07 0.20
Arms Fat HF 0.16 0.13 0.16 0.45* 0.40 0.26
Control 0.39* 0.23 0.03 0.44* 0.02 0.20
* p!0.05, **p!0.01, ***p!0.001
023 Obese Patients with Equivalent NYHA Have Less Cardiac Impairment Than Non-Obese Counterparts Shanmugakumar Chinnappa1, Nigel Lewis1, David Goldspink2, Diane Barker1, Lip-Bun Tan1; 1Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 2 University of Leeds, Leeds, United Kingdom Background: The management of obese heart failure (HF) patients has been confounded by evidence that their prognosis is better and their BNP levels lower than their non-obese counterparts. We set out to characterise the cardiac and physical functional reserves of obese HF patients and compare with those of non-obese counterparts and healthy controls. Methods: We studied male heart failure patients in NYHA classes II and III and compared their physical and cardiac functional reserves between those with BMI O34 kg/m2 (O) and BMI #30 (NonO). We assessed them relative to healthy male volunteers (C, n5101) with no known cardiovascular diseases spanning the entire adult age range (19-76 years) with BMI 25.45 60.33, who served as control subjects. They underwent weight-bearing treadmill exercise testing with standard respiratory gas analyses and non-invasive haemodynamics including rebreathing method of measuring cardiac outputs during peak exercise. Results: The HF patients consisted of 24 obese (O, BMI 44.966.8) and 30 non-obese (NonO, BMI 25.062.9) patients with similar mean age (O: 4968(SD), NonO: 49615 years), and similar NYHA functional classes (O: 2.5060.50; NonO: 2.4860.51). The obese had lower peak O2 uptake per kg body weight (O: 18.464.2 vs NonO: 20.563.7 ml/min/kg, p!0.01). However, the obese HF patients had significantly higher aerobic exercise capacity (O: 2.57560.748 vs NonO: 1.59460.325 L/min, p!10 6), associated with significantly higher cardiac pumping capability (peak cardiac power output of 4.561.6 W (O) vs 2.460.6 W (NonO), p! 10 6). On average the obese HF patients had aerobic capacity equivalent to 91.6623.4% of healthy controls and cardiac reserve of 85.8628.1% of controls, whereas their non-obese counterparts had significantly lower values with 58.9614.6% and 46.1611.1% respectively (all p!10 6). Conclusion: These results showed that despite similar mean age and NYHA functional classes, the obese HF patients had significantly less impairment in their cardiac functional reserve than their non-obese counterparts, suggesting a crucial discrepancy between subjective impressions and objective evaluation of HF severity in obese HF patients.
024 Fat Measurement and Functional Characteristics in Heart Failure Patients A. Zavin1, K. Allsup1, D.R. Gagnon6,7, R. Arena4, S. Davis1, J. Joseph1,2, S. Lecker2, A. Lazzari1,3, P.C. Schulze5, D.E. Forman1,2; 1VA Boston Healthcare System, Boston, MA; 2Harvard Medical School, Boston, MA; 3Boston University School of Medicine, Boston, MA; 4University of New Mexico, Albuquerque, NM; 5Columbia University Medical Center, New York, NY; 6Boston University SPH, Boston, MA; 7VA Cooperative Studies Program, Boston, MA Introduction: Prior studies indicate that increased exercise capacity corresponds to improved prognosis in a HF population. Past work also indicates that increased adipose tissue (based on body mass index [BMI]) corresponds to improved prognosis. To better understand the cardioprotective benefits of adiposity, dual-energy x-ray absorptiometry (DXA) was used to characterize fat mass (FM) in relation to functional capacity (aerobic and strength) in HF. Hypothesis: Increased FM corresponds to functional benefits in HF patients. Methods: 51 men were studied (mean age 66.9610 years), 20 euvolemic, systolic HF patients (LVEF#40%) and 31 healthy controls. DXA was used to assess FM (total and appendicular [legs and arms]). CPX was used to assess aerobic indices: peak oxygen consumption (VO2), VO2 at anaerobic threshold (VAT), and ventilatory efficiency (VE/VCO2 slope). A pneumatic
Conclusion: Adiposity may stimulate increased strength capacities in HF patients, an effect that helps explain the paradoxical mortality benefits with which adiposity is also attributed. Further research regarding the paradoxical health benefits of adiposity in HF is still needed.
025 Pacing from a Novel Quadripolar LV Lead Improves LV Synchrony in CRT Patients Gery F. Tomassoni1, Melody Muir1, Erin O’Brien2, Kyungmoo Ryu2, Aaron Hesselson1; 1Lexington Cardiology Consultants, Lexington, KY; 2St. Jude Medical, Sylmar, CA LV circumferential strain analysis using Velocity Vector Imaging (VVI) has been used to assess acute response to CRT. Recently, a new quadripolar LV lead (Quartet, St. Jude Medical) with 10 different pacing vectors (VectSelect: 3 conventional [ConV], 7 unconventional [NConV]) has been developed to improve CRT response by providing more pacing options for CRT programming. We report our initial experience using VVI to assess the LV strain response with the Quartet post CRT implant. Methods: Eight male ischemic patients (7168 yrs old, LV EF 2765%) with LBBB (QRSd 154621 ms) and persistent Class III CHF underwent CRT implant with the Quartet LV lead. The lead location was mid-distal posterolateral or lateral in all patients. Real-time 6 segment LV circumferential tissue strain analysis using VVI software (Siemens) was performed during pacing from each of all 10 pacing vectors at 2X the capture voltage at 24 hrs discharge (n58), 3 (n56), 6 (n55), and 12 (n51) months post implant. In addition, strain analysis was performed at 3, 6, and 12 months post implant during high output pacing (7.5V/1 ms) at each of 10 pacing vectors. AV interval remained constant for all pacing interventions at each visit for each patient. A 6 segment time-to-peak strain of opposing LV segments O130 ms was defined as dyssynchrony. Results: Resynchronization was achieved in all patients at each visit by pacing from at least one pacing vector. If ConV were used only, LV resynchronization would not have occurred in 3 patients (38%) during 12 months post implant. ConV resynchronized the LV in 29/60 (48%) vs. NConV in 65/131 (50%). 28/73 (38%), 35/59 (59%), 29/48 (60%), and 7/10 (70%) pacing vectors demonstrated resynchronization at 24 hrs, 3, 6, and 12 months respectively. Pacing with NConV resulted in the greatest reduction in dyssynchrony in 63%, 83%, 80%, and 100% of the patients at 24 hrs, 3, 6, and 12 months, respectively. High output pacing resulted in 41/88 (47%) pacing vectors with resynchronization. When a dyssynchronous pattern was present at certain pacing vectors, high output pacing resynchronized the LV in 17/43 (40%). Conclusions: The Quartet LV lead along with CRT device equipped with a VectSelect feature adds 7 NConV vectors which can increase the chance of LV resynchronization. In addition, the percentage of pacing vectors that resynchronize the LV appears to increase at 3, 6, and 12 months post implant. Finally, high output pacing can resynchronize a LV dyssynchronous pattern in 40% of the time.
026 Hematological Malignancies Are Associated with Significant Elevations in N-Terminal Pro Brain Natriuretic Peptide Jesal Popat, Abel Rivero, Maya Guglin; Department of Cardiovascular Medicine, University of South Florida, Tampa, FL Background: It has previously been stated that cancer patients frequently have marked elevations in brain natriuretic peptide (BNP) levels. This finding has been more commonly observed in patients with solid tumors compared to those with hematologic malignancies. Furthermore, the degree of elevation does not always appear