Cardiac sympathetic reserve and response to cardiac resynchronization therapy

Yong Mei Cha, Panithaya Chareonthaitawee, Ying Xue Dong, Bradley J. Kemp, Jae K. Oh, Chinami Miyazaki, David L. Hayes, Robert F. Rea, Samuel J. Asirvatham, Tracy L. Webster, Connie M. Dalzell, David O. Hodge, Regina M. Herges, Yan Zhong Yong, Yanhua Zhang, Peng Sheng Chen

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Background-The objective of the present study was to investigate the effect of cardiac resynchronization therapy (CRT) on cardiac autonomic function. Methods and Results-This prospective study included 45 consecutive patients with heart failure who received CRT devices with defibrillator and 20 age-matched, healthy control subjects. At baseline and 3 months and 6 months after CRT, we assessed New York Heart Association (NYHA) class, 6-minute walk distance, plasma sympathetic biomarker nerve growth factor, echocardiography, heart rate variability and cardiac presynaptic sympathetic function determined by iodine 123 metaiodobenzylguanidine scintigraphy. After CRT, NYHA class improved by 1 class (P<0.001), and left ventricular ejection fraction increased by 8% (P<0.001). Along with improvement in the standard deviation of all normal-to-normal R-R intervals (85.63±31.66 ms versus 114.79±38.99 ms; P=0.004) and the standard deviation of the averaged normal-to-normal R-R intervals (82.62±23.03 ms versus 100.50±34.87 ms; P=0.004), the delayed heart/mediastinum (H/M) ratio increased (1.82 [0.58] versus 1.97 [0.59]; P-0.03), whereas the mean (SD) H/M washout rate was reduced (48% [19%] versus 37% [22%]; P=0.01). Twenty-two of 45 study patients responded to CRT, with a reduction of left ventricular end-systolic volume index >15%. Compared with nonresponders, responders had a higher delayed H/M ratio (2.11 versus 1.48; P=0.003) and lower H/M washout rate (37% versus 62%; P=0.003) at baseline. Conclusions-CRT improved sympathetic function. Cardiac sympathetic reserve may be a marker for the reversibility of failing myocardial function.

Original languageEnglish (US)
Pages (from-to)339-344
Number of pages6
JournalCirculation: Heart Failure
Issue number3
StatePublished - May 1 2011


  • Cardiac resynchronization therapy
  • Heart failure
  • Metaiodobenzylguanidine iodine 123
  • Nerve growth factor
  • Sympathetic nerve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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