Arterial Stiffness Clinical Trial
Official title:
Response To Cardiac Resynchronization Therapy In Heart Failure: Role Of Arterial Stiffness
To determine if arterial stiffness as measured by non-invasive pulse wave velocity can predict the response to resynchronization therapy in heart failure.
The patients receiving CRT are medically refractory, symptomatic, NYHA class III or IV
disease and QRS duration of 130 m sec or greater, and a left ventricular ejection fraction
of 30 percent or less.
The pulse wave velocity between carotid and femoral (PWVcf) will be recorded in each subject
at base line (before and after CRT), at one month (after AV delay optimization) and again at
6 months after CRT. The arterial pulse wave is recorded at a proximal artery, such as the
carotid artery, and as well as at a distal artery, such as the femoral artery. The
superficial location of the carotid and femoral arteries means that their pulse waveforms
are readily measured noninvasively using the M Hz Doppler probe, and between these two sites
the pulse wave has to travel through most of the aorta. The time delay between the arrival
of a predefined part of the pulse wave, such as the foot, at these 2 points is obtained by
gating to the peak of the R-wave of the ECG. The distance traveled by the pulse wave is
measured over the body surface and PWV is then calculated as distance/time (m/s).
Clinical evidence of response: Either one or more of the following: 1) Improvement in NYHA
functional classification, 2) Improvement in 6 minute walking distance. 3) Change in
functional class, exercise tolerance while the heart is getting smaller on CXR. 4)
Stabilization of patient CHF even without subjective improvement over 6 months (remaining
class III rather than progressive to class IV). Imaging evidence of response: 1) Increase in
left ventricular ejection fraction. 2) Reduction of mitral regurgitation. 3) Reduction of LV
volume signifying reverse remodeling.
;
Observational Model: Case-Only, Time Perspective: Prospective
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