Comparison of different invasive hemodynamic methods for AV delay optimization in patients with cardiac resynchronization therapy: implications for clinical trial design and clinical practice.

Détails

Ressource 1Télécharger: BIB_DA37D890024E.P001.pdf (975.36 [Ko])
Etat: Serval
Version: Final published version
ID Serval
serval:BIB_DA37D890024E
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Comparison of different invasive hemodynamic methods for AV delay optimization in patients with cardiac resynchronization therapy: implications for clinical trial design and clinical practice.
Périodique
International Journal of Cardiology
Auteur(s)
Whinnett Z.I., Francis D.P., Denis A., Willson K., Pascale P., van Geldorp I., De Guillebon M., Ploux S., Ellenbogen K., Haïssaguerre M., Ritter P., Bordachar P.
ISSN
1874-1754 (Electronic)
ISSN-L
0167-5273
Statut éditorial
Publié
Date de publication
2013
Volume
168
Numéro
3
Pages
2228-2237
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Résumé
BACKGROUND: Reproducibility and hemodynamic efficacy of optimization of AV delay (AVD) of cardiac resynchronization therapy (CRT) using invasive LV dp/dtmax are unknown.
METHOD AND RESULTS: 25 patients underwent AV delay (AVD) optimisation twice, using continuous left ventricular (LV) dp/dtmax, systolic blood pressure (SBP) and pulse pressure (PP). We compared 4 protocols for comparing dp/dtmax between AV delays: We assessed for dp/dtmax, LVSBP and LVPP, test-retest reproducibility of the optimum. Optimization using immediate absolute dp/dtmax had poor reproducibility (SDD of replicate optima=41 ms; R(2)=0.45) as did delayed absolute (SDD 39 ms; R(2)=0.50). Multiple relative had better reproducibility: SDD 23 ms, R(2)=0.76, and (p<0.01 by F test). Compared with AAI pacing, the hemodynamic increment from CRT, with the nominal AV delay was LVSBP 2% and LVdp/dtmax 5%, while CRT with pre-determined optimal AVD gave 6% and 9% respectively.
CONCLUSIONS: Because of inevitable background fluctuations, optimization by absolute dp/dtmax has poor same-day reproducibility, unsuitable for clinical or research purposes. Reproducibility is improved by comparing to a reference AVD and making multiple consecutive measurements. More than 6 measurements would be required for even more precise optimization--and might be advisable for future study designs. With optimal AVD, instead of nominal, the hemodynamic increment of CRT is approximately doubled.
Pubmed
Web of science
Open Access
Oui
Création de la notice
15/07/2014 9:09
Dernière modification de la notice
09/05/2019 2:03
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