Prospective comparison of echocardiographic atrioventricular delay optimization methods for cardiac resynchronization therapy
| Autor: | Judy L. Osborn, Sanjeev Garhwal, Jeffrey E. Kerlan, Navinder Sawhney, Alan D. Waggoner, Mitchell N. Faddis, Mohit K. Chawla |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Cardiac resynchronization therapy Doppler echocardiography QRS complex Physiology (medical) Mitral valve Internal medicine medicine Humans Prospective Studies cardiovascular diseases Heart Failure Ejection fraction medicine.diagnostic_test Cardiac cycle business.industry Cardiac Pacing Artificial Stroke Volume Stroke volume Middle Aged medicine.disease Echocardiography Doppler Treatment Outcome medicine.anatomical_structure Heart failure Atrioventricular Node Linear Models cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine business circulatory and respiratory physiology |
| Zdroj: | Heart Rhythm. 3:148-154 |
| ISSN: | 1547-5271 |
| Popis: | BACKGROUND Atrioventricular (AV) delay optimization can be an important determinant of the response to cardiac resynchronization therapy (CRT) in patients with medically refractory heart failure and a ventricular conduction delay. OBJECTIVES The purpose of this study was to compare two Doppler echocardiographic methods of AV delay optimization after CRT. METHODS Forty consecutive patients (age 59 12 years) with severe heart failure, New York Heart Association class 3.1 0.4, QRS duration 177 23 ms, and left ventricular ejection fraction 26% 6% referred for CRT were studied using two-dimensional Doppler echocardiography. In each patient, the acute improvement in stroke volume with CRT in response to two methods of AV delay optimization was compared. In the first method, the AV delay that produced the largest increase in the aortic velocity time integral (VTI) derived from continuous-wave Doppler (aortic VTI method) was measured. In the second method, the AV delay that optimized the timing of mitral valve closure to occur simultaneously with the onset of left ventricular systole was calculated from pulsed Doppler mitral waveforms at a short and long AV delay interval (mitral inflow method). RESULTS The optimized AV delay determined by the aortic VTI method resulted in an increase in aortic VTI of 19% 13% compared with an increase of 12% 12% by the mitral inflow method (P .001). The optimized AV delay by the aortic VTI method was significantly longer than the optimized AV delay calculated from the mitral inflow method (119 34 ms vs 95 24 ms, P .001). There was no correlation in the AV delay determined by the two methods (r 0.03). CONCLUSION AV delay optimization by Doppler echocardiography for patients with severe heart failure treated with a CRT device yields a greater systolic improvement when guided by the aortic VTI method compared with the mitral inflow method. |
| Databáze: | OpenAIRE |
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