Cardiac Resynchronization Therapy Optimization Using Noninvasive Cardiac Output Measurement

Autor:	Simon P. Fynn, Philip A. Read, Fakhar Z. Khan, Beverley Smith, David P. Dutka, John Hutchinson, Peter J. Pugh, Munmohan Virdee
Rok vydání:	2011
Předmět:	medicine.medical_specialty Cardiac output Ejection fraction business.industry medicine.medical_treatment Cardiac resynchronization therapy General Medicine Av delay Nyha class Cardiac output measurement Quality of life Internal medicine Physical therapy medicine Cardiology Cardiology and Cardiovascular Medicine business End-systolic volume
Zdroj:	Pacing and Clinical Electrophysiology. 34:1527-1536
ISSN:	0147-8389
DOI:	10.1111/j.1540-8159.2011.03172.x
Popis:	Aims: Noninvasive cardiac output (CO) measurement (NICOM) is a novel method to assess ventricular function and offers a potential alternative for optimization of cardiac resynchronization therapy (CRT) devices. We compared the effect of NICOM-based optimization to no optimization (empiric settings) on CRT outcomes. Methods: Two hundred and three patients undergoing CRT were assessed in two consecutive nonrandomized groups; an empiric group (n = 54) was programmed to “out of the box” settings with a fixed AV delay of 120 ms and a VV delay of 0 ms; and the optimization group (n = 149) underwent adjustments of both the AV and VV delays according to the greatest improvement in resting CO. The primary endpoints were improvements in left ventricular (LV) volumes and function from baseline at 6 months. Secondary endpoints were change in New York Heart Association (NYHA) class, quality of life score, and 6-minute walk test (6 MWT) performance. Results: After 6 months of CRT, the optimization group had a better clinical response with lower NYHA class (2.1±0.8 vs 2.4 ± 0.8, P = 0.048) and quality of life scores (35 ± 18 vs 42 ± 20, P = 0.045) but no differences in 6-MWT performance (269 ± 110 vs 277 ± 114 m, P = 0.81). Echocardiographic response was also better in the optimization group with lower LV end systolic volume (108 ± 51 vs 126 ± 60 mL, P = 0.048) and higher ejection fraction (30 ± 7 vs 27 ± 8, P = 0.01) compared to empiric settings. Conclusion: Device optimization using noninvasive measures of CO is associated with better clinical and echocardiographic response compared to empiric settings. (PACE 2011; 34:1527–1536)
Databáze:	OpenAIRE
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