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Original research article
Measures of endothelial dysfunction predict response to cardiac resynchronisation therapy
  1. David R Warriner1,2,
  2. Patricia Lawford1 and
  3. Paul J Sheridan1,2
  1. 1Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
  2. 2Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
  1. Correspondence to Dr David R Warriner; d.r.warriner{at}


Objectives Cardiac resynchronisation therapy (CRT) improves morbidity and mortality in heart failure (HF). Impaired endothelial function, as measured by flow-mediated dilation (FMD) is associated with increased morbidity and mortality in HF and may help to differentiate responders from non-responders.

Methods 19 patients were recruited, comprising 94% men, mean age 69±8 years, New York Heart Association functional classes II–IV, QRSd 161±21 ms and mean left ventricular ejection fraction 26±8%. Markers of response and FMD were measured at baseline, 6 and 12 months following CRT.

Results 14 patients were responders to CRT. Responders had significant improvements in VO2 (12.6±1.7 to 14.7±1.5 mL/kg/min, p<0.05), quality of life score (44.4±22.9–24.1±21.3, p<0.01), left ventricular end diastolic volume (201.5±72.5 mL–121.3±72.0 mL, p<0.01) and 6-min walk distance (374.0±112.8 m at baseline to 418.1±105.3 m, p<0.05). Baseline FMD in responders was 2.9±1.9% and 7.4±3.73% in non-responders (p<0.05).

Conclusions Response to CRT at 6 and 12 months is predicted by baseline FMD. This study confirms that FMD identifies responders to CRT, due to endothelium-dependent mechanisms alone.

  • Flow Mediated Dilation

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