Echocardiographic optimization favors greater reduction in left ventricular end-diastolic volume compared to electrocardiographic optimization in patients with cardiac resynchronization therapy

    Authors

    Abstract

    **Introduction**: Cardiac resynchronization therapy (CRT) is a widely used method in the treatment of symptomatic patients with advanced heart failure and LBBB. Its beneficial impact on the reduction of left ventricular (LV) volumes has already been shown. (1, 2) The aim of this study was to determine if echocardiographic optimization of CRT pacing intervals (ECHO) after CRT device implantation has a favorable impact on LV volume change compared to electrocardiographic optimization (ECG). **Patients and Methods**: An overall of 147 patients with implanted CRT according to guidelines were included in this study and divided into two groups according to the CRT optimization method (N=70 in ECG arm an N=77 in ECHO arm). ECG optimization was performed using 12-lead electrocardiogram, fusion-optimized intervals, intracardiac electrogram-based algorithms and electrocardiographic imaging. ECHO optimization implied correction of atrioventricular, inter- and intraventricular dyssynchrony using echocardiographic imaging. The change in LV end-diastolic (EDV), end-systolic (ESV) and stroke volume (SV) as well as LV ejection fraction (EF) was compared between groups, before and 6 months after CRT implantation. **Results**: EDV and ESV significantly decreased and EF increased in both groups. In the ECHO a statistically significant reduction in EDV compared to ECG was present (p=0.028). According to greater EDV reduction, SV significantly decreased in ECHO (p=0.026). No significance was observed in ESV change between groups (p=0.063) (**Table 1**). ### TABLE 1: Left ventricle volumes and ejection fraction change before and 6 months after cardiac resynchronization therapy between the analyzed groups. | | **ECG (N=70)** | **ECG (N=70)** | **ECG (N=70)** | **ECHO (N=77)** | **ECHO (N=77)** | **ECHO (N=77)** | | | --- | --- | --- | --- | --- | --- | --- | --- | | | Before CRT | 6 months after CRT | Mean change, SD | Before CRT | 6 months after CRT | Δ | | | EDV (ml) | 218.81 | 167.48 | 51.32 (±64.25) | 231.81 | 157.53 | 74.28 (±80.25) | **p= 0.028** | | ESV (ml) | 162.27 | 112.25 | 50.01 (±59.38) | 169.67 | 102.57 | 67.1 (±75.02) | p= 0.063 | | SV (ml) | 56.54 | 55.23 | 1.31 (±16.46) | 62.14 | 54.96 | 7.18 (±19.66) | **p= 0.026** | | EF (%) | 26.67 | 36.79 | 10.11 (±8.39) | 26.97 | 39.13 | 12.16 (±10.80) | p= 0.1 | [†] EDV - left ventricular end-diastolic volume, ESV - left ventricular end-systolic volume, SV - left ventricular stroke volume, EF - left ventricular ejection fraction, SD - standard deviation. **Conclusion**: ECHO optimization of CRT leads to a more significant reduction of EDV compared to ECG optimization after 6 months of follow up.

    Keywords

    cardiac resynchronization therapy, echocardiographic optimization, left ventricular volume

    DOI

    https://doi.org/10.15836/ccar2021.203

    Literature

    1. St John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio DB, Leon AR, et al. Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study Group. Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation. 2003 April 22;107(15):1985–90. https://doi.org/10.1161/01.CIR.0000065226.24159.E9
    2. St John Sutton M, Cerkvenik J, Borlaug BA, Daubert C, Gold MR, Ghio S, et al. Effects of Cardiac Resynchronization Therapy on Cardiac Remodeling and Contractile Function: Results From Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE). J Am Heart Assoc. 2015 September 11;4(9):e002054. https://doi.org/10.1161/JAHA.115.002054
    Cardiologia Croatica
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    Echocardiographic optimization favors greater reduction in left ventricular end-diastolic volume compared to electrocardiographic optimization in patients with cardiac resynchronization therapy

    Extended Abstract
    Issue5-6
    Published
    Pages203
    PDF via DOIhttps://doi.org/10.15836/ccar2021.203
    cardiac resynchronization therapy
    echocardiographic optimization
    left ventricular volume

    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
    Kristina GašparovićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Jadranka Šeparović HanževačkiORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia

    *Correspondence email: marija.brestovac@gmail.com

    Abstract

    **Introduction**: Cardiac resynchronization therapy (CRT) is a widely used method in the treatment of symptomatic patients with advanced heart failure and LBBB. Its beneficial impact on the reduction of left ventricular (LV) volumes has already been shown. (1, 2) The aim of this study was to determine if echocardiographic optimization of CRT pacing intervals (ECHO) after CRT device implantation has a favorable impact on LV volume change compared to electrocardiographic optimization (ECG). **Patients and Methods**: An overall of 147 patients with implanted CRT according to guidelines were included in this study and divided into two groups according to the CRT optimization method (N=70 in ECG arm an N=77 in ECHO arm). ECG optimization was performed using 12-lead electrocardiogram, fusion-optimized intervals, intracardiac electrogram-based algorithms and electrocardiographic imaging. ECHO optimization implied correction of atrioventricular, inter- and intraventricular dyssynchrony using echocardiographic imaging. The change in LV end-diastolic (EDV), end-systolic (ESV) and stroke volume (SV) as well as LV ejection fraction (EF) was compared between groups, before and 6 months after CRT implantation. **Results**: EDV and ESV significantly decreased and EF increased in both groups. In the ECHO a statistically significant reduction in EDV compared to ECG was present (p=0.028). According to greater EDV reduction, SV significantly decreased in ECHO (p=0.026). No significance was observed in ESV change between groups (p=0.063) (**Table 1**). ### TABLE 1: Left ventricle volumes and ejection fraction change before and 6 months after cardiac resynchronization therapy between the analyzed groups. | | **ECG (N=70)** | **ECG (N=70)** | **ECG (N=70)** | **ECHO (N=77)** | **ECHO (N=77)** | **ECHO (N=77)** | | | --- | --- | --- | --- | --- | --- | --- | --- | | | Before CRT | 6 months after CRT | Mean change, SD | Before CRT | 6 months after CRT | Δ | | | EDV (ml) | 218.81 | 167.48 | 51.32 (±64.25) | 231.81 | 157.53 | 74.28 (±80.25) | **p= 0.028** | | ESV (ml) | 162.27 | 112.25 | 50.01 (±59.38) | 169.67 | 102.57 | 67.1 (±75.02) | p= 0.063 | | SV (ml) | 56.54 | 55.23 | 1.31 (±16.46) | 62.14 | 54.96 | 7.18 (±19.66) | **p= 0.026** | | EF (%) | 26.67 | 36.79 | 10.11 (±8.39) | 26.97 | 39.13 | 12.16 (±10.80) | p= 0.1 | [†] EDV - left ventricular end-diastolic volume, ESV - left ventricular end-systolic volume, SV - left ventricular stroke volume, EF - left ventricular ejection fraction, SD - standard deviation. **Conclusion**: ECHO optimization of CRT leads to a more significant reduction of EDV compared to ECG optimization after 6 months of follow up.

    Literature

    1. 1.
      St John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio DB, Leon AR, et al. Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study Group. Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation. 2003 April 22;107(15):1985–90.DOI
    2. 2.
      St John Sutton M, Cerkvenik J, Borlaug BA, Daubert C, Gold MR, Ghio S, et al. Effects of Cardiac Resynchronization Therapy on Cardiac Remodeling and Contractile Function: Results From Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE). J Am Heart Assoc. 2015 September 11;4(9):e002054.DOI