Key result
Interventricular delay optimization using systolic dyssynchrony index fails to improve volumetric response over QRS width.
Why the study?
Does interventricular delay optimisation using systolic dyssynchrony index improve left ventricle volume reduction compared to QRS width assessment in patients with recently implanted CRT?
RCT (n=63)
Open-label
randomised
Does interventricular delay optimisation using systolic dyssynchrony index improve left ventricle volume reduction compared to QRS width assessment in patients with recently implanted CRT?
Absolute Event Rate: 62.5% vs 54.8%
p-value: p=0.786
Optimising interventricular delay in CRT using 3D echocardiography-derived systolic dyssynchrony index does not provide additional volumetric or clinical benefit over simple QRS width assessment.
Advanced optimization adds no volumetric benefit in CRT; confirms QRS assessment suffices for interventricular delay programming.
BACKGROUND: The aim of our study was to compare the effect of interventricular (VV) delay optimisation in CRT recipients on the basis of systolic dyssynchrony index (SDI) derived from the three-dimensional echocardiography (3DE) versus QRS width assessment on left ventricle volume reduction at the 12-month follow-up. METHODS: We included 63 patients with recently implanted CRT in this randomised, open-label trial. Patients were randomised to VV delay optimisation according to QRS complex width measurement in group 1 (n = 31) to obtain the narrowest QRS complex and SDI in group 2 (n = 32) to achieve its lowest possible value. We evaluated left ventricular end-systolic volume (LVESv), left ventricular ejection fraction (LVEF) and SDI by 3DE before CRT implantation and at a 12-month follow-up in all the patients. We also obtained the New York Heart Association functional class, the 6-minute walk test, the quality of life questionnaire and the level of NT-proBNP. RESULTS: The number of volumetric responders was similar in both groups (17 vs. 20, P = 0.786). There were also no significant differences in the reduction of LVESv (-41 ± 55 mL vs. - 61 ± 51 mL, P = 0.111), improvement in LVEF (+10.1 ± 10.6% vs. + 13.0 ± 9.9%, P = 0.213) or differences in clinical outcomes between both groups at the 12-month follow-up. CONCLUSION: CRT optimisation of interventricular delay using SDI compared with QRS width assessment did not reveal any significant difference in terms of volumetric and clinical response at the 12-month follow-up.
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Vondrák et al. (2017) conducted an RCT in Recently implanted cardiac resynchronisation therapy (CRT) (n=63). Interventricular (VV) delay optimisation using systolic dyssynchrony index (SDI) vs. VV delay optimisation using QRS complex width measurement was evaluated on Volumetric response (left ventricle volume reduction) (p=0.786). Interventricular delay optimization using the systolic dyssynchrony index did not significantly improve the rate of volumetric responders compared to QRS width assessment (62.5% vs 54.8%; P=0.786).
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