Additional benefit of echocardiographic optimization of cardiac resynchronization therapy devices according to specific echocardiographic and clinical parameters

    Authors

    Keywords

    cardiac resynchronization therapy optimization, echocardiographic optimization, myocardial dyssynchrony

    DOI

    https://doi.org/10.15836/ccar2023.139

    Full Text

    Introduction : Cardiac resynchronization therapy (CRT) contributes to left ventricle ejection fraction and NYHA improvement in patients with severe heart failure. In literature, echocardiographic (ECHO) benefits of CRT were found in a wide spectrum of different ECHO parameters. ( 1 - 4 ) In this study we compared ECHO benefit of echocardiographic optimization of CRT device with the standard, ECG method in a spectrum of different ECHO parameters. Patients and Methods : An overall of 146 patients were analyzed according to the method of CRT optimization. The first group (OPT) was optimized by ECHO signs of dyssynchrony whereas the second group (ECG) was analyzed using QRS duration. Changes in QRS duration, NYHA, left ventricle end-systolic volume (ΔESV), end-diastolic volumen (ΔEDV), ejection fraction (ΔEF), global longitudinal strain (GLS), mean pulmonary artery pressure (PAP), mitral regurgitation (MR), ΔNTproBNP, septal flash (SF), atrioventricular dyssynchrony (AVd), interventricular dyssynchrony using difference in onset of pulmonary and aortic ejection (PV/AV) and quality of life using SF-36 questionnaire were compared between the groups in a follow up period of 6 months. Results : No additional benefit of one group over the other was found for QRS duration reduction (p=0.366), NYHA (p=0.221), ΔESV (p=0.093), ΔEF (p=0.218), GLS (p=0.665), MR (p=0.278), PAP (p=0.433) and QoL (p=0.213) whereas a faster and higher reduction in ΔEDV (p=0.045), ΔNTproBNP (p=0.037), SF (p=0.0014), AVd (p=0.002), PV/AV (p=0.041) was found in OPT group favoring ECHO optimization. Conclusion : Echocardiographic optimization of CRT contributes to an additional echocardiographic benefit over the standard method in reduction of NTproBNP, ΔEDV and SF, AVd and PV/AV.

    Cardiologia Croatica
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    Additional benefit of echocardiographic optimization of cardiac resynchronization therapy devices according to specific echocardiographic and clinical parameters

    Extended Abstract
    Issue5-6
    Published
    Pages139
    PDF via DOIhttps://doi.org/10.15836/ccar2023.139
    cardiac resynchronization therapy optimization
    echocardiographic optimization
    myocardial dyssynchrony

    Authors

    Marija Brestovac*ORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Blanka Glavaš KonjaORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Martina Lovrić BenčićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Vlatka Rešković LukšićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Sandra Jakšić JurinjakORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Joško BulumORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Zvonimir OstojićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Kristina GašparovićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Jadranka Šeparović HanževačkiORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia

    Full Text

    Introduction : Cardiac resynchronization therapy (CRT) contributes to left ventricle ejection fraction and NYHA improvement in patients with severe heart failure. In literature, echocardiographic (ECHO) benefits of CRT were found in a wide spectrum of different ECHO parameters. ( 1 - 4 ) In this study we compared ECHO benefit of echocardiographic optimization of CRT device with the standard, ECG method in a spectrum of different ECHO parameters. Patients and Methods : An overall of 146 patients were analyzed according to the method of CRT optimization. The first group (OPT) was optimized by ECHO signs of dyssynchrony whereas the second group (ECG) was analyzed using QRS duration. Changes in QRS duration, NYHA, left ventricle end-systolic volume (ΔESV), end-diastolic volumen (ΔEDV), ejection fraction (ΔEF), global longitudinal strain (GLS), mean pulmonary artery pressure (PAP), mitral regurgitation (MR), ΔNTproBNP, septal flash (SF), atrioventricular dyssynchrony (AVd), interventricular dyssynchrony using difference in onset of pulmonary and aortic ejection (PV/AV) and quality of life using SF-36 questionnaire were compared between the groups in a follow up period of 6 months. Results : No additional benefit of one group over the other was found for QRS duration reduction (p=0.366), NYHA (p=0.221), ΔESV (p=0.093), ΔEF (p=0.218), GLS (p=0.665), MR (p=0.278), PAP (p=0.433) and QoL (p=0.213) whereas a faster and higher reduction in ΔEDV (p=0.045), ΔNTproBNP (p=0.037), SF (p=0.0014), AVd (p=0.002), PV/AV (p=0.041) was found in OPT group favoring ECHO optimization. Conclusion : Echocardiographic optimization of CRT contributes to an additional echocardiographic benefit over the standard method in reduction of NTproBNP, ΔEDV and SF, AVd and PV/AV.