Key result
VV delay optimization improves echocardiographic indices beyond standard CRT across multiple imaging methods.
Why the study?
The study aimed to compare three different echocardiographic methods for interventricular interval optimization in patients undergoing CRT to determine concordance and benefit beyond standard settings.
Do different echocardiographic methods for interventricular interval optimization yield concordant results and improve indices beyond standard CRT in patients undergoing CRT?
Do different echocardiographic methods for interventricular interval optimization yield concordant results and improve indices beyond standard CRT in patients undergoing CRT?
p-value: p=<0.001
Different echocardiographic methods for VV-interval optimization in CRT patients show significant concordance and provide additional hemodynamic benefit over standard CRT.
May support VV optimization in CRT; leaves open whether echocardiographic gains improve clinical outcomes.
AIM OF THE STUDY: To compare three different methods for obtaining interventricular-(VV) interval optimization. METHODS: A total of 30 patients undergoing cardiac resynchronization therapy (CRT) were enrolled. All the patients underwent VV-interval optimization performed with three different echocardiographic methods at seven different settings: simultaneous right (RV) and left (LV) ventricular pacing, LV stimulation only, LV preexcitation (LV+20,+40,+60 ms, respectively), RV preexcitation (RV+20 and+40 ms, respectively). Optimal VV delay was selected by: (1) measuring the aortic velocity time integral (VTI method); (2) measuring the time to maximum delay between septal and lateral longitudinal motion in the four-chamber view (velocity method); and (3) measuring the segment with maximal temporal difference of peak circumferential strain in short-axis view at papillary muscles level, (strain method). Velocity and strain methods measurements were obtained relying on two-dimensional ultrasound border tracking algorithm thus providing angle-independent measurements. RESULTS: Immediately after CRT, VTI, maximum peak circumferential strain delay and maximum septal-to-lateral delay were significantly improved (P < 0.001). Particularly, VV-interval optimization determined a further improvement of these indices as compared to the other VV settings (P < 0.001). Furthermore, a substantial concordance was found between the optimal VV interval obtained according to the VTI method and velocity method (k = 0.68), between the optimal VV interval obtained according to the VTI method and strain method (k = 0.63); and between the optimal VV interval obtained according to the velocity method and strain method (k = 0.71). CONCLUSIONS: VV-interval optimization was shown to determine a further benefit beyond CRT. A significant concordance was present between VV programming based on different echocardiographic methods.
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Bertini et al. (2009) studied Patients undergoing cardiac resynchronization therapy (CRT) (n=30). Interventricular (VV) delay optimization using three echocardiographic methods vs. Other VV settings was evaluated on Improvement of VTI, maximum peak circumferential strain delay, and maximum septal-to-lateral delay (p=<0.001). Interventricular delay optimization provided further improvement in echocardiographic indices beyond CRT alone (P<0.001), with substantial concordance among VTI, velocity, and strain methods.
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