Document Detail


Correlation of echo-Doppler optimization of atrioventricular delay in cardiac resynchronization therapy with invasive hemodynamics in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.
MedLine Citation:
PMID:  16461055     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study investigated the optimal echocardiographic indexes to determine the most hemodynamically appropriate atrioventricular (AV) delay in cardiac resynchronization therapy (CRT) for heart failure. Doppler echocardiographic optimization of AV delay in CRT has not been correlated with invasive hemodynamic indexes. In 30 patients who underwent CRT, invasive left ventricular (LV) pressure measurements with a sensor-tipped pressure guidewire and Doppler echocardiographic examination were performed <24 hours after pacemaker implantation. Invasively, the optimal sensed AV delay was determined by LV dP/dt(max). The Doppler echocardiographic methods evaluated were the velocity-time integral (VTI) of the transmitral flow (EA VTI), diastolic filling time (EA duration), the VTI of the LV outflow tract or aorta (LV VTI), and Ritter's formula. Biventricular pacing with optimized interventricular and AV delay increased LV dP/dt(max) from 777 +/- 149 to 1,010 +/- 163 dynes/s (p<0.0001). The optimal AV delay with the EA VTI method was concordant with LV dP/dt(max) in 29 of 30 patients (r = 0.96), with EA duration in 20 of 30 patients (r= 0.83), with LV VTI in 13 patients (r = 0.54), and with Ritter's formula in none of the patients (r = 0.35). In conclusion, to obtain the optimal acute hemodynamic benefit of CRT, Doppler echocardiography is a reliable tool to optimize the AV delay compared with the invasive LV dP/dt(max). The measurement of the maximal VTI of mitral inflow is the most accurate method.
Authors:
Annemieke H M Jansen; Frank A Bracke; Jan M van Dantzig; Albert Meijer; Pepijn H van der Voort; Wilbert Aarnoudse; Berry M van Gelder; Kathinka H Peels
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-01-04
Journal Detail:
Title:  The American journal of cardiology     Volume:  97     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-07     Completed Date:  2006-03-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  552-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands. annemieke.jansen@cze.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrioventricular Node / physiopathology*
Cardiomyopathy, Dilated / complications*
Echocardiography, Doppler / methods*
Female
Heart Failure / physiopathology,  therapy*,  ultrasonography*
Heart Ventricles / physiopathology
Hemodynamics*
Humans
Male
Pacemaker, Artificial*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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