Endothelial injury in patients with heart failure: Correlation of flow mediated dilation and circulating markers of endothelial function

Background: Cardiac resynchronization therapy (CRT) of selected heart failure (HF) patients improves both morbidity and mortality. In this study a review of the operative complications, the need for lead reimplantations, clinical benefit and mortality is presented. Material and methods: From 1999 to 2006 CRTwas implanted in 150 HF patients with average age 66+11 years. The Medtronic Insync pulse generator and leads were used. Results: In 35% of the operations it was difficult to find the coronary sinus ostium, and 16% intraoperative dislocations of the coronary venous lead occurred. After 2 year follow up 16% of the patients needed reimplantations of the coronary venous lead. On unchanged HF medications an improvement in NYHA functional class from 3.3±0.6 at baseline to 2.4±0.7 (pb0.001) at 1 year follow up and further to 2.1±0.5 (pb0.001) at 2 years follow up was found. Two year mortality was 27.9%. Interpretation: The current technique for coronary venous lead implantation is safe, but on long term one out of 6 patients needed reimplantation coronary venous lead because of dislocations. The patients experienced a significant and stable improvement of functional capacity for the 2 years of follow up.