Iterative Cardiac Output Measurement for Optimizing Cardiac Resynchronization Therapy: A Randomized, Blinded, Crossover Study

Reinsch, Nico; Konorza, Thomas; Woydowski, Dagmar; Bruck, Heike; Volsek, Michaela; Müller‐Tasch, Thomas; Neumann, Till; Erbel, Raimund; Wieneke, Heinrich

doi:10.1111/j.1540-8159.2010.02848.x

Cited by 7 publications

(9 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We believe 6‐MWT improvement to be particularly important as this is a more realistic reflection of the daily activity these patients undergo as compared to a protocol‐driven treadmill test. This confirms the findings of previous studies, which also optimized both AV and VV delay at rest, in showing an important functional improvement in 6‐MWT distance . There was also a significant improvement in echocardiographic dyssynchrony as measured by Ts‐SD.…”

Section: Discussionsupporting

confidence: 90%

“…This confirms the findings of previous studies, which also optimized both AV and VV delay at rest, in showing an important functional improvement in 6-MWT distance. 17,18 There was also a significant improvement in echocardiographic dyssynchrony as measured by Ts-SD. In addition, all other trial endpoints-both clinical and echocardiographic-showed improvement also (albeit NS).…”

Section: Resting Crt Optimizationmentioning

confidence: 87%

See 1 more Smart Citation

Hemodynamic Benefit of Rest and Exercise Optimization of Cardiac Resynchronization Therapy

et al. 2014

View full text Add to dashboard Cite

The optimal method of cardiac resynchronization therapy (CRT) optimization is as yet unknown. We sought to investigate the responses of optimization at rest and on exercise. This 2 stage study involved 59 patients (age 65 ± 10, 75% male), who had all recently undergone successful CRT implantation. In the first stage, the 6-month response was compared between 30 individuals who underwent resting echocardiographic optimization of CRT [atrioventricular (AV delay) plus ventriculo-ventricular delays (VV delay)], compared with the 29 who did not. In the second stage, a subset of 37 patients from the original cohort were randomized (double-blind) to either resting echocardiographic optimization (n = 20) or exercise echocardiographic optimization (n = 17) and followed for a further 6 months. Clinical and echocardiographic data were collected at each stage. Patients undergoing rest optimization demonstrated improvement in almost all variables and significantly in B-type natriuretic peptide (BNP) in contrast to those without optimization. In a linear regression model, the only significant predictor of BNP change was whether an individual underwent resting optimization or not (β = 0.38, P = 0.04). In those undergoing resting optimization, the degree of change in AV delay was correlated with improvement in left ventricle (LV) end-diastolic volume (r(2) = 0.33, P < 0.01). Optimization on exercise was associated with a significant decrease in 6-minute walk test compared to those randomized to rest optimization possibly due to inducing nonoptimization at rest. In conclusion, echocardiographic optimization of CRT at rest is superior to no optimization or optimization on exercise. Patients with the greatest change in AV delay to reach optimal may undergo greater LV remodeling.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Resting Crt Optimizationmentioning

confidence: 87%

Hemodynamic Benefit of Rest and Exercise Optimization of Cardiac Resynchronization Therapy

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Given the long delay in the delayed response to CRT, it is possible that other factors besides CRT might cause the observed improvement. Several studies have shown that beta‐blocker titration and device programming optimization were associated with improvements in CRT efficacy. However, in our study, we did not find any other possible causes for the delayed response apart from CRT.…”

Section: Discussionmentioning

confidence: 99%

The incidence and outcomes of delayed response to cardiac resynchronization therapy

Zhang

Hou

et al. 2017

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background: The incidence and clinical outcomes of delayed response to cardiac resynchronization therapy (CRT) have not been well clarified. We aimed to observe the incidence and prognosis of delayed response and to identify its possible mechanisms.Methods: A total of 115 CRT patients were retrospectively analyzed in our study. Patients who met the enrollment criteria were divided into two groups: group A, conventional responders who showed response at 1-year follow-up, and group B, delayed responders who showed response after 1-year follow-up. CRT response was defined as an absolute increase of ≥10% in left ventricular ejection fraction.Results: Fifty-two patients (61 ± 12 years, 37 male) experienced conventional response to CRT and 17 patients (63 ± 11 years, 10 male) experienced delayed response. The mean follow-up time was 5.2 ± 2.4 years. The incidence of delayed response was 14.8% (17/115). All-cause mortality and hospitalization rates for heart failure were similar for delayed and conventional responders.Multivariate logistic regression analysis revealed that scar burden > 35% was an independent predictor of CRT delayed response (odds ratio 8.794, P = 0.038). Conclusions:A significant proportion of patients demonstrated delayed response to CRT. The delayed responders had a good prognosis that was similar to that of conventional responders.More scar burden might be related to the incidence of delayed response.

show abstract

“…Nejsou-li přítomny v plicním řečišti významné AV zkraty, rovná se průtok plícemi minutovému výdeji. Systém byl k optimalizaci stimulačních intervalů použit opakovaně s dobrými výsledky [23][24][25].…”

Section: Neinvazivní Měření Minutového Výdejeunclassified

“…V další tentokrát malé monocentrické dvojitě zaslepené randomizované překřížené studii zahrnující 24 osob se používal k optimalizaci srdeční výdej měřený přístrojem Innocor. Optimální hodnota stimulačních intervalů vedla ke statisticky významně lepší toleranci zátěže [23].…”

Section: Obr 2 -Metoda Výpočtu Optimálního Av Intervalu Podle Meluzínaunclassified

Optimization of pacing intervals in cardiac resynchronization therapy

Ulč¹,

Vančura²

2013

Cor Vasa

View full text Add to dashboard Cite

U osob s chronickým srdečním selháním při významné systolické dysfunkci levé komory a prodlouženém komplexu QRS slouží srdeční resynchronizační léčba (SRL) k nápravě synchronicity depolarizace myokardu. Míra zlepšení klinického stavu a echokardiografi ckého nálezu po jejím zavedení však závisí na různých parametrech -strukturálních změnách myokardu, poruchách nitrokomorového vedení a umístění stimulačních elektrod. K individualizaci léčby lze na implantovaných SRL přístrojích nastavit různé parametry, z nichž nejdůležitější jsou AV a VV intervaly. Ačkoliv jejich optimalizace byla předmětem rozsáhlých klinických studií, nepochybný důkaz o prospěšnosti optimalizace těchto intervalů stále chybí. Nejčastěji se k hodnocení optimalizace používá echokardiografi e a metody založené na intrakardiální elektrokardiografi i. Kvůli nedostatkům ve statistickém zpracování však nelze označit některou z metod jako referenční nebo použitelnou v každodenní klinické praxi. Echokardiografi e je zatížena značnou variabilitou výsledků, jejichž kvalita je navíc silně závislá na zkušenosti vyšetřujícího. Optimalizace na podkladě intrakardiálních elektrokardiogramů zatím neprokázala jasně lepší výsledky než empirické nastavení přístroje. Slibnější metodou se zatím jeví hodnocení hemodynamiky prstovou pletysmografi í, neboť získaná data jsou vysoce reproducibilní a nezávislá na erudici vyšetřujícího. Zatím však chybějí randomizované multicentrické dvojitě zaslepené studie s prstovou pletysmografií, které by zhodnotily význam této metody v optimalizaci SRL. Měření informačního obsahu jakýchkoliv dat týkajících se optimalizace SRL, analýza jejich reproducibility a všeobecné používání konfi denčních intervalů by mohly též pomoci nalézt další použitelné metody. Při hodnocení výsledků je často nezbytná úzká spolupráce se statistikem.

show abstract

Iterative Cardiac Output Measurement for Optimizing Cardiac Resynchronization Therapy: A Randomized, Blinded, Crossover Study

Abstract: CRT optimization by iterative CO measurements leads to an increase in CO and an improvement of exercise capacity. Our results suggest that this method might become an important additive tool to adjust CRT programming.

Cited by 7 publications

References 30 publications

Hemodynamic Benefit of Rest and Exercise Optimization of Cardiac Resynchronization Therapy

Hemodynamic Benefit of Rest and Exercise Optimization of Cardiac Resynchronization Therapy

The incidence and outcomes of delayed response to cardiac resynchronization therapy

Optimization of pacing intervals in cardiac resynchronization therapy

Contact Info

Product

Resources

About