Comparison of Dyssynchrony Parameters for VV-Optimization in CRT Patients.
Background Optimization of the interventricular delay (VV-optimization) in cardiac resynchronization therapy (CRT) patients can be performed by evaluation of mechanical dyssynchrony. However, there is no consensus on which method to use. In this study, three conceptually different methods were evalu...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 36; no. 11; pp. 1382 - 1391 |
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| Autores principales: | , , , , , , , |
| Formato: | diagnostic images research tables/charts tracings Journal Article |
| Publicado: |
Wiley-Blackwell
Nov2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104147702&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104147702 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Nov2013 vid: 36 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 104147702 91615075 10.1111/pace.12203 NLM23827016 104147702 ppf: 1382 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Comparison of Dyssynchrony Parameters for VV-Optimization in CRT Patients. aug: au: Risum, Niels Sogaard, Peter Hansen, Thomas F. Bruun, Niels E. Hoffmann, Soren Kisslo, Joseph Jons, Christian Olsen, Niels T. affil: Department of Cardiology, Gentofte University Hospital sug: subj: Heart Failure Therapy Pacemaker, Artificial Methods Human Echocardiography Methods Descriptive Statistics Intrarater Reliability Ventricular Ejection Fraction Bundle-Branch Block T-Tests Wilcoxon Signed Rank Test Mann-Whitney U Test Post Hoc Analysis Female Male Aged Middle Age Data Analysis Software Confidence Intervals Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Background Optimization of the interventricular delay (VV-optimization) in cardiac resynchronization therapy (CRT) patients can be performed by evaluation of mechanical dyssynchrony. However, there is no consensus on which method to use. In this study, three conceptually different methods were evaluated. Methods Thirty consecutive CRT patients were included. At day 1, patients were atrioventricular and VV optimized by left ventricular outflow tract (LVOT) velocity time integral (VTI). At 6 months, 2D strain (2DS) echocardiography and tissue Doppler imaging (TDI) was performed at six different VV-programming delay in steps of 20 ms. LVOT and three indices of dyssynchrony were evaluated at each setting: standard deviation (SD) of time-to-peak strain in 12 segments (2DS-SD), SD of time-to-peak velocities in 12 segments (TDI-SD), and maximal activation delay (AD-max) by cross-correlation analysis (XCA) of TDI-derived myocardial acceleration curves. Results Feasibility was 90% for 2DS-SD and TDI-SD and 97% for AD-max. Coefficients of variation for intraobserver variability were 13% for 2DS-SD, 11% for TDI-SD, and 6% for AD-max. A relative increase in LVOT VTI > 10% was observed in 5/12 (42%) nonresponders and 7/18 (39%) responders to CRT. Optimization by all three dyssynchrony indices significantly increased LVOT VTI compared to simultaneous pacing and optimal setting at day 1 (P < 0.05, all). LVOT VTI was highest when using AD-max, and AD-max showed the best agreement (k = 0.71). Conclusion VV optimization at 6 months acutely benefits both responders and nonresponders; however, dyssynchrony indices do not perform equally well. XCA has a high feasibility and reproducibility and appears to be superior to time-to-peak techniques. pubtype: Academic Journal doctype: diagnostic images research tables/charts tracings Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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