Evaluation of the therapeutic effects of QuickOpt optimization in Chinese patients with chronic heart failure treated by cardiac resynchronization

Yan, Ji; Zhang, Shu; Huang, Dejia; Xue, Xiaolin; Xu, Jianguo; Qiu, Tao; Zhang, Weize; Zhang, Zheng; Hua, Wei; Tang, Baopeng; Xu, Wei; Xu, Geng; Ren, Xuejun; Wang, Jingfeng; Guo, Tao; Jia, Shanshan; Dong, Yugang; Jiang, Hong; Fu, Guosheng; Zhu, Ling; Chen, Lin; Tian, Fang; Ling, Feng; Li, Jianmei; Qi, Xiaoyong; Hao, Yinglu; Wang, Yutang; Zheng, Liangrong; Pu, Xiao-qun; Shen, Farong; Li, Guangping; Li, Hui; Peng, Fang

doi:10.1038/s41598-018-22525-0

Cited by 8 publications

(14 citation statements)

References 20 publications

(20 reference statements)

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“…In a subgroup of 25 patients, device settings were optimized by maximizing the invasively determined maximal rate of LV pressure rise (dP/dt max ) during the implantation procedure [ 17 ]. In the remaining 10 patients, algorithms based on the intracardiac electrogram implemented in the devices were used for device optimization [ 18 ]. Echocardiographic response to CRT was assessed by the reduction in LV end-systolic volume, with responders defined as patients with > 15% reduction at 6 months (“long-term”) follow-up [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

Wouters

Leenders

Meine

et al. 2021

Int J Cardiovasc Imaging

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Purpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

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Section: Methodsmentioning

confidence: 99%

Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

Wouters

Leenders

Meine

et al. 2021

Int J Cardiovasc Imaging

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“…Two main factors that determine better outcomes are the optimization of atrial-to-ventricular (AV) and ventricular-to-ventricular (VV) delay (Naqvi et al, 2006). Reviewing the literature on echocardiography versus IEGM-based optimization of CRT, we found out that programming can be performed with the IEGM-based algorithm and the results are comparable with the optimization performed with the echocardiogram (Baker et al, 2007;Giammaria et al, 2016;Hua et al, 2012;Jensen et al, 2011;Kamdar et al, 2010;Pezo Nikolić et al, 2017;Reinsch et al, 2009;Sawhney et al, 2004;Wang et al, 2013;Yan et al, 2018;Zhang et al, 2019). Usually, passive ventricular filling occurs in early and mid-diastolic phases, with the blood flowing from the atrium to the ventricle secondary to AV pressure difference.…”

Section: Discussionmentioning

confidence: 87%

“…Intracardiac electrocardiogram uses different timing cycle optimization algorithms that rapidly determine optimal AV and VV intervals based on heart electrical activity (Abraham et al, 2010;AlTurki et al, 2019;Hu et al, 2022;Wang et al, 2020;Yan et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Echocardiography‐ versus intracardiac electrocardiogram‐based optimization of cardiac resynchronization therapy: A systematic review

Sami

Mustafa²,

Butt

et al. 2023

Noninvasive Electrocardiol

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“…However, complex electrocardiographic algorithms to set the AV delay, such as Smart-AV and QuickOpt, failed to “optimize” response rates in randomized controlled trials [6, 28]. In this regard, a recent multicenter study reported that NYHA class, specific activity scale (SAS), and 6MWT improved similarly at 12 months in the groups optimized by QuickOpt or echocardiography, although there was a significant difference in the time required for optimization by QuickOpt [34]. A randomized study to compare VV optimization to default simultaneous biventricular pacing also showed that selecting the VV according to pulsed Doppler echocardiography had no clinical benefit at the 6-month follow-up [35].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Effect of Different Optimizing Methods for Cardiac Resynchronization Therapy in Patients with Heart Failure: A Randomized and Controlled Pilot Study

et al. 2019

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Aim: During cardiac resynchronization therapy (CRT), optimized programming of the atrioventricular (AV) delay and ventricular-to-ventricular (VV) interval can lead to improved hemodynamics, symptomatic response, and left ventricular systolic function. Currently, however, there is no recommendation for the best optimization method. This study aimed to compare the long-term clinical outcomes of 4 different CRT optimization methods. Methods: One hundred and twenty-four consecutive CRT patients with severe heart failure and left bundle-branch block configuration were randomly assigned into four groups to undergo AV/VV delay optimization through echocardiogram (ECHO; n = 30), electrocardiogram (ECG; n = 32), QuickOpt algorithm (n = 28), and nominal AV/VV (n = 36) groups. Patients were followed up and underwent examinations, including New York Heart Association (NYHA) cardiac functional classification, 6-min walking distance (6MWD), and echocardiography, at 6, 12, 24, 36, and 48 months, respectively. The patients’ survival and clinical outcomes were compared among the four groups. Results: Kaplan-Meier survival analyses showed that the median survival was the same in the 4 groups: ECHO, 43 months; ECG, 44 months; QuickOpt, 44 months, and nominal, 41 months. At the 6-month follow-up, the reduction in left ventricular end diastolic diameter (LVEDD) was significantly less in the nominal group (–1.91 ± 2.58 mm) than that in the other three groups (ECHO: –3.70 ± 2.78 mm, p = 0.012; ECG: –3.53 ± 3.14 mm, p = 0.020; QuickOpt: –3.46 ± 2.65 mm, p = 0.032); 6MWD was significantly shorter in the nominal group (87.88 ± 34.76 m) than that in the other three groups (ECHO: 120.63 ± 56.93 m, p = 0.006; ECG: 114.97 ± 54.95 m, p = 0.020; QuickOpt: 114.57 ± 35.41 m, p = 0.027). Left ventricular ejection fraction (LVEF) significantly increased in ECHO (7.23 ± 2.76%, p = 0.010), ECG (8.50 ± 3.17%, p < 0.001), and QuickOpt (8.39 ± 2.90%, p < 0.001) compared with the nominal group (5.35 ± 2.59%). There were no significant differences among the groups in the aforementioned parameters at 24, 36, and 48 months, respectively. Conclusion: While LVEDD, LVEF, 6MWD, and NYHA were significantly improved in ECHO, ECG, and QuickOpt at 6 months, there were no significant improvements in any of the groups at 12, 24, and 48 months. These findings suggested that the long-term effect of the four CRT methods for heart failure was not significantly different.

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Evaluation of the therapeutic effects of QuickOpt optimization in Chinese patients with chronic heart failure treated by cardiac resynchronization

Cited by 8 publications

References 20 publications

Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

Echocardiography‐ versus intracardiac electrocardiogram‐based optimization of cardiac resynchronization therapy: A systematic review

Long-Term Effect of Different Optimizing Methods for Cardiac Resynchronization Therapy in Patients with Heart Failure: A Randomized and Controlled Pilot Study

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