Biventricular pacemaker therapy improves exercise capacity in patients with non‐obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise

Ibrar Ahmed; Brodie L. Loudon; Khalid Abozguia; Donnie Cameron; Ganesh N. Shivu; Thanh T. Phan; Abdul Maher; Berthold Stegemann; Anthony Chow; Howard Marshall; Peter Nightingale; Francisco Leyva; Vassilios S. Vassiliou; William J. Mckenna; Perry Elliott; Michael P. Frenneaux

doi:10.1002/ejhf.1722

Biventricular pacemaker therapy improves exercise capacity in patients with non‐obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise

Ibrar Ahmed
, Brodie L. Loudon
, Khalid Abozguia
, Donnie Cameron
, Ganesh N. Shivu
, Thanh T. Phan
, Abdul Maher
, Berthold Stegemann
, Anthony Chow
, Howard Marshall
, Peter Nightingale
, Francisco Leyva
, Vassilios S. Vassiliou
, William J. Mckenna
, Perry Elliott
, Michael P. Frenneaux

Department of Cardiovascular Medicine University of Birmingham Birmingham UK
University of East Anglia, Norwich Medical School
Lancashire Cardiac Centre Blackpool Victoria Hospital Blackpool UK
Cardiology Department Royal Stoke University Hospital UHNM NHS Trust Newcastle UK
Department of Cardiovascular Medicine Royal Berkshire NHS Foundation Trust Reading UK
Queen Elizabeth Hospital Birmingham Welcome Trust Clinical Research Facility Birmingham UK
Institute of Cardiovascular Science, University College of London London UK

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

15 Downloads (Pure)

Abstract

Aims
Treatment options for patients with non‐obstructive hypertrophic cardiomyopathy (HCM) are limited. We sought to determine whether biventricular (BiV) pacing improves exercise capacity in HCM patients, and whether this is via augmented diastolic filling.

Methods and results
Thirty‐one patients with symptomatic non‐obstructive HCM were enrolled. Following device implantation, patients underwent detailed assessment of exercise diastolic filling using radionuclide ventriculography in BiV and sham pacing modes. Patients then entered an 8‐month crossover study of BiV and sham pacing in random order, to assess the effect on exercise capacity [peak oxygen consumption (VO2)]. Patients were grouped on pre‐specified analysis according to whether left ventricular end‐diastolic volume increased (+LVEDV) or was unchanged/decreased (–LVEDV) with exercise at baseline. Twenty‐nine patients (20 male, mean age 55 years) completed the study. There were 14 +LVEDV patients and 15 –LVEDV patients. Baseline peak VO2 was lower in –LVEDV patients vs. +LVEDV patients (16.2 ± 0.9 vs. 19.9 ± 1.1 mL/kg/min, P = 0.04). BiV pacing significantly increased exercise ΔLVEDV (P = 0.004) and Δstroke volume (P = 0.008) in –LVEDV patients, but not in +LVEDV patients. Left ventricular ejection fraction and end‐systolic elastance did not increase with BiV pacing in either group. This translated into significantly greater improvements in exercise capacity (peak VO2 + 1.4 mL/kg/min, P = 0.03) and quality of life scores (P = 0.02) in –LVEDV patients during the crossover study. There was no effect on left ventricular mechanical dyssynchrony in either group.

Conclusion
Symptomatic patients with non‐obstructive HCM may benefit from BiV pacing via augmentation of diastolic filling on exercise rather than contractile improvement. This may be due to relief of diastolic ventricular interaction.

Clinical Trial Registration: ClinicalTrials.gov NCT00504647.

Original language	English
Pages (from-to)	1263-1272
Number of pages	10
Journal	European Journal of Heart Failure
Volume	22
Issue number	7
Early online date	23 Jan 2020
DOIs	https://doi.org/10.1002/ejhf.1722
Publication status	Published - 1 Jul 2020

Bibliographical note

© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Keywords

Biventricular pacemaker therapy
Diastolic ventricular interaction
Hypertrophic cardiomyopathy

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10.1002/ejhf.1722Licence: CC BY 3.0

Biventricular pacemaker therapy improves exercise capacity
© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Final published version, 1.99 MBLicence: CC BY 3.0

Cite this

Ahmed, I., Loudon, B. L., Abozguia, K., Cameron, D., Shivu, G. N., Phan, T. T., Maher, A., Stegemann, B., Chow, A., Marshall, H., Nightingale, P., Leyva, F., Vassiliou, V. S., Mckenna, W. J., Elliott, P., & Frenneaux, M. P. (2020). Biventricular pacemaker therapy improves exercise capacity in patients with non‐obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise. European Journal of Heart Failure, 22(7), 1263-1272. https://doi.org/10.1002/ejhf.1722

@article{76fca0703adf462eb045e3efc30bab07,

title = "Biventricular pacemaker therapy improves exercise capacity in patients with non‐obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise",

abstract = "Aims Treatment options for patients with non‐obstructive hypertrophic cardiomyopathy (HCM) are limited. We sought to determine whether biventricular (BiV) pacing improves exercise capacity in HCM patients, and whether this is via augmented diastolic filling. Methods and results Thirty‐one patients with symptomatic non‐obstructive HCM were enrolled. Following device implantation, patients underwent detailed assessment of exercise diastolic filling using radionuclide ventriculography in BiV and sham pacing modes. Patients then entered an 8‐month crossover study of BiV and sham pacing in random order, to assess the effect on exercise capacity [peak oxygen consumption (VO2)]. Patients were grouped on pre‐specified analysis according to whether left ventricular end‐diastolic volume increased (+LVEDV) or was unchanged/decreased (–LVEDV) with exercise at baseline. Twenty‐nine patients (20 male, mean age 55 years) completed the study. There were 14 +LVEDV patients and 15 –LVEDV patients. Baseline peak VO2 was lower in –LVEDV patients vs. +LVEDV patients (16.2 ± 0.9 vs. 19.9 ± 1.1 mL/kg/min, P = 0.04). BiV pacing significantly increased exercise ΔLVEDV (P = 0.004) and Δstroke volume (P = 0.008) in –LVEDV patients, but not in +LVEDV patients. Left ventricular ejection fraction and end‐systolic elastance did not increase with BiV pacing in either group. This translated into significantly greater improvements in exercise capacity (peak VO2 + 1.4 mL/kg/min, P = 0.03) and quality of life scores (P = 0.02) in –LVEDV patients during the crossover study. There was no effect on left ventricular mechanical dyssynchrony in either group. Conclusion Symptomatic patients with non‐obstructive HCM may benefit from BiV pacing via augmentation of diastolic filling on exercise rather than contractile improvement. This may be due to relief of diastolic ventricular interaction. Clinical Trial Registration: ClinicalTrials.gov NCT00504647.",

keywords = "Biventricular pacemaker therapy, Diastolic ventricular interaction, Hypertrophic cardiomyopathy",

author = "Ibrar Ahmed and Loudon, \{Brodie L.\} and Khalid Abozguia and Donnie Cameron and Shivu, \{Ganesh N.\} and Phan, \{Thanh T.\} and Abdul Maher and Berthold Stegemann and Anthony Chow and Howard Marshall and Peter Nightingale and Francisco Leyva and Vassiliou, \{Vassilios S.\} and Mckenna, \{William J.\} and Perry Elliott and Frenneaux, \{Michael P.\}",

note = "{\textcopyright} 2020 The Authors. European Journal of Heart Failure published by John Wiley \& Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.",

year = "2020",

month = jul,

day = "1",

doi = "10.1002/ejhf.1722",

language = "English",

volume = "22",

pages = "1263--1272",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "Oxford University Press",

number = "7",

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Ahmed, I, Loudon, BL, Abozguia, K, Cameron, D, Shivu, GN, Phan, TT, Maher, A, Stegemann, B, Chow, A, Marshall, H, Nightingale, P, Leyva, F, Vassiliou, VS, Mckenna, WJ, Elliott, P & Frenneaux, MP 2020, 'Biventricular pacemaker therapy improves exercise capacity in patients with non‐obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise', European Journal of Heart Failure, vol. 22, no. 7, pp. 1263-1272. https://doi.org/10.1002/ejhf.1722

Biventricular pacemaker therapy improves exercise capacity in patients with non‐obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise. / Ahmed, Ibrar; Loudon, Brodie L.; Abozguia, Khalid et al.
In: European Journal of Heart Failure, Vol. 22, No. 7, 01.07.2020, p. 1263-1272.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Biventricular pacemaker therapy improves exercise capacity in patients with non‐obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise

AU - Ahmed, Ibrar

AU - Loudon, Brodie L.

AU - Abozguia, Khalid

AU - Cameron, Donnie

AU - Shivu, Ganesh N.

AU - Phan, Thanh T.

AU - Maher, Abdul

AU - Stegemann, Berthold

AU - Chow, Anthony

AU - Marshall, Howard

AU - Nightingale, Peter

AU - Leyva, Francisco

AU - Vassiliou, Vassilios S.

AU - Mckenna, William J.

AU - Elliott, Perry

AU - Frenneaux, Michael P.

N1 - © 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

PY - 2020/7/1

Y1 - 2020/7/1

N2 - Aims Treatment options for patients with non‐obstructive hypertrophic cardiomyopathy (HCM) are limited. We sought to determine whether biventricular (BiV) pacing improves exercise capacity in HCM patients, and whether this is via augmented diastolic filling. Methods and results Thirty‐one patients with symptomatic non‐obstructive HCM were enrolled. Following device implantation, patients underwent detailed assessment of exercise diastolic filling using radionuclide ventriculography in BiV and sham pacing modes. Patients then entered an 8‐month crossover study of BiV and sham pacing in random order, to assess the effect on exercise capacity [peak oxygen consumption (VO2)]. Patients were grouped on pre‐specified analysis according to whether left ventricular end‐diastolic volume increased (+LVEDV) or was unchanged/decreased (–LVEDV) with exercise at baseline. Twenty‐nine patients (20 male, mean age 55 years) completed the study. There were 14 +LVEDV patients and 15 –LVEDV patients. Baseline peak VO2 was lower in –LVEDV patients vs. +LVEDV patients (16.2 ± 0.9 vs. 19.9 ± 1.1 mL/kg/min, P = 0.04). BiV pacing significantly increased exercise ΔLVEDV (P = 0.004) and Δstroke volume (P = 0.008) in –LVEDV patients, but not in +LVEDV patients. Left ventricular ejection fraction and end‐systolic elastance did not increase with BiV pacing in either group. This translated into significantly greater improvements in exercise capacity (peak VO2 + 1.4 mL/kg/min, P = 0.03) and quality of life scores (P = 0.02) in –LVEDV patients during the crossover study. There was no effect on left ventricular mechanical dyssynchrony in either group. Conclusion Symptomatic patients with non‐obstructive HCM may benefit from BiV pacing via augmentation of diastolic filling on exercise rather than contractile improvement. This may be due to relief of diastolic ventricular interaction. Clinical Trial Registration: ClinicalTrials.gov NCT00504647.

AB - Aims Treatment options for patients with non‐obstructive hypertrophic cardiomyopathy (HCM) are limited. We sought to determine whether biventricular (BiV) pacing improves exercise capacity in HCM patients, and whether this is via augmented diastolic filling. Methods and results Thirty‐one patients with symptomatic non‐obstructive HCM were enrolled. Following device implantation, patients underwent detailed assessment of exercise diastolic filling using radionuclide ventriculography in BiV and sham pacing modes. Patients then entered an 8‐month crossover study of BiV and sham pacing in random order, to assess the effect on exercise capacity [peak oxygen consumption (VO2)]. Patients were grouped on pre‐specified analysis according to whether left ventricular end‐diastolic volume increased (+LVEDV) or was unchanged/decreased (–LVEDV) with exercise at baseline. Twenty‐nine patients (20 male, mean age 55 years) completed the study. There were 14 +LVEDV patients and 15 –LVEDV patients. Baseline peak VO2 was lower in –LVEDV patients vs. +LVEDV patients (16.2 ± 0.9 vs. 19.9 ± 1.1 mL/kg/min, P = 0.04). BiV pacing significantly increased exercise ΔLVEDV (P = 0.004) and Δstroke volume (P = 0.008) in –LVEDV patients, but not in +LVEDV patients. Left ventricular ejection fraction and end‐systolic elastance did not increase with BiV pacing in either group. This translated into significantly greater improvements in exercise capacity (peak VO2 + 1.4 mL/kg/min, P = 0.03) and quality of life scores (P = 0.02) in –LVEDV patients during the crossover study. There was no effect on left ventricular mechanical dyssynchrony in either group. Conclusion Symptomatic patients with non‐obstructive HCM may benefit from BiV pacing via augmentation of diastolic filling on exercise rather than contractile improvement. This may be due to relief of diastolic ventricular interaction. Clinical Trial Registration: ClinicalTrials.gov NCT00504647.

KW - Biventricular pacemaker therapy

KW - Diastolic ventricular interaction

KW - Hypertrophic cardiomyopathy

UR - https://onlinelibrary.wiley.com/doi/10.1002/ejhf.1722

UR - https://www.scopus.com/pages/publications/85078654263

U2 - 10.1002/ejhf.1722

DO - 10.1002/ejhf.1722

M3 - Article

C2 - 31975494

SN - 1388-9842

VL - 22

SP - 1263

EP - 1272

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

IS - 7

ER -

Biventricular pacemaker therapy improves exercise capacity in patients with non‐obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise

Abstract

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Keywords

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