Key result
Echocardiographic optimization of CRT devices significantly improved acute hemodynamics, including reducing interventricular mechanical delay from 71.3 to 24.7 ms (p<0.001).
Why the study?
Does echocardiographic optimization of CRT devices improve acute hemodynamic parameters in patients with severe left ventricular systolic dysfunction?
Observational (n=62)
Does echocardiographic optimization of CRT devices improve acute hemodynamic parameters in patients with severe left ventricular systolic dysfunction?
Absolute Event Rate: 24.7% vs 71.3%
p-value: p=<0.001
Echocardiographic optimization of CRT devices significantly improves acute hemodynamic parameters, emphasizing the need for an individualized approach to device programming.
Echocardiographic CRT optimization was associated with acute hemodynamic gains; hypothesis-generating for individualized programming pending randomized confirmation.
Cardiac resynchronization therapy (CRT) improves ventricular dyssynchrony and is associated with an improvement in life quality and prognosis. Aim. The aim of study was to examine acute hemodynamic changes with different of CRT device modalities throughout optimization procedure and its impact on one year prognosis. Material and methods. The study comprised 62 patients with severe left ventricular systolic dysfunction (LVEF 24,6±4,4%, QRS duration 154,71±14,92 ms, NYHA class III/IV 47/15) with implanted CRT device. After implantation and before discharge all the patients underwent optimization procedure guided by Doppler echocardiography. Left (LVPEI) and right (RVPEI) ventricular pre-ejection intervals, interventricular mechanical delay (IVD) and the maximal rate of ventricular pressure rise during early systole (max dP/dt) were measured during left and biventricular pacing with three different atrioventricular (AV) delays. Stroke volume derived from the left ventricular outflow tract velocity–time integral (VTI) of left ventricular outflow tract (LVOT VTI) was measured as well. After one year patients underwent clinical, echocardiographical examination and 6 minute walking test. Results. After CRT device optimization, optimal AV delay and CRT mode were defined. Left ventricular pre-ejection intervals changed from 175,4±21,5 to 142,6±16,7 (p < 0,01), RVPEI from 108,6±18,9 to 127,3±18,3 (p < 0,001), IVD from 71,3±14,8 to 24,7±7,6 (p < 0,001) and dP/dt from 532,2±74 to 675,2±111 (p < 0,001). Left ventricular outflow tract VTI increased after optimization procedure from 18±3,4 to 21±1,5 cm (p<0,05). Conclusions. Echocardiographic optimization procedure emphasizes the individualized approach in CRT optimization procedure in order to derive the best short and long term results.
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Šalinger-Martinović et al. (2014) conducted an observational in Severe left ventricular systolic dysfunction with implanted CRT device (n=62). Echocardiographic optimization of CRT device vs. Pre-optimization baseline was evaluated on Interventricular mechanical delay (IVD) (p=<0.001). Echocardiographic optimization of CRT devices significantly improved acute hemodynamics, including reducing interventricular mechanical delay from 71.3 to 24.7 ms (p<0.001).
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