BACKGROUND: Acute changes of the AV-delay in CRT patients have a significant impact on hemodynamics. However, the chronic functional effects of AV-delay optimization have not been systematically examined despite of their potential role for chronic functional improvement. METHODS: Therefore, in this study we investigated whether optimization of AV-delay in CRT patients as assessed by echocardiographic measurement of the velocity time integral of the left ventricular outflow tract (LVOT-VTI) chronically changes (1) echocardiographic parameters of systolic and diastolic left ventricular function, (2) walking distance in the 6-min walk test, (3) levels of NT-proBNP and (4) quality of life as assessed by a standard questionnaire. 33 patients underwent optimization of AV-delay 31+/-8 weeks after initiation of CRT. Follow up (FU) was conducted 43+/-5 days later. RESULTS: E/Ea, the ratio of peak E-wave of mitral inflow and of TDI of the mitral annulus, significantly decreased immediately post-optimization (11+/-1 vs. 14+/-1 at baseline, p<0.05) and further decreased at FU (8+/-1, p<0.05 vs. immediately post-optimization) indicating improvement of diastolic function, while traditional parameters of diastolic function derived from pulse wave Doppler remained unchanged. There was a slight increase of LV-ejection fraction as assessed by echocardiography acutely after optimization (baseline: 25+/-2%, optimized: 28+/-1%, p<0.05), while LV-ejection fraction at FU did not differ from baseline. 6-min walk test improved from 449+/-17 m (baseline) to 475+/-17 m at FU (p<0.05). During this period NT-proBNP significantly decreased from 3193+/-765 ng/l to 2593+/-675 ng/l (p<0.05). Quality of life was unchanged at FU. CONCLUSION: This study demonstrates for the first time chronic functional improvement due to AV-delay optimization in patients with CRT.
BACKGROUND: Acute changes of the AV-delay in CRT patients have a significant impact on hemodynamics. However, the chronic functional effects of AV-delay optimization have not been systematically examined despite of their potential role for chronic functional improvement. METHODS: Therefore, in this study we investigated whether optimization of AV-delay in CRT patients as assessed by echocardiographic measurement of the velocity time integral of the left ventricular outflow tract (LVOT-VTI) chronically changes (1) echocardiographic parameters of systolic and diastolic left ventricular function, (2) walking distance in the 6-min walk test, (3) levels of NT-proBNP and (4) quality of life as assessed by a standard questionnaire. 33 patients underwent optimization of AV-delay 31+/-8 weeks after initiation of CRT. Follow up (FU) was conducted 43+/-5 days later. RESULTS: E/Ea, the ratio of peak E-wave of mitral inflow and of TDI of the mitral annulus, significantly decreased immediately post-optimization (11+/-1 vs. 14+/-1 at baseline, p<0.05) and further decreased at FU (8+/-1, p<0.05 vs. immediately post-optimization) indicating improvement of diastolic function, while traditional parameters of diastolic function derived from pulse wave Doppler remained unchanged. There was a slight increase of LV-ejection fraction as assessed by echocardiography acutely after optimization (baseline: 25+/-2%, optimized: 28+/-1%, p<0.05), while LV-ejection fraction at FU did not differ from baseline. 6-min walk test improved from 449+/-17 m (baseline) to 475+/-17 m at FU (p<0.05). During this period NT-proBNP significantly decreased from 3193+/-765 ng/l to 2593+/-675 ng/l (p<0.05). Quality of life was unchanged at FU. CONCLUSION: This study demonstrates for the first time chronic functional improvement due to AV-delay optimization in patients with CRT.
Authors: Konstantin A Krychtiuk; Michael Nürnberg; Romana Volker; Linda Pachinger; Rudolf Jarai; Matthias K Freynhofer; Johann Wojta; Kurt Huber; Thomas W Weiss Journal: Wien Klin Wochenschr Date: 2014-03-21 Impact factor: 1.704
Authors: Ethan Kung; James C Perry; Christopher Davis; Francesco Migliavacca; Giancarlo Pennati; Alessandro Giardini; Tain-Yen Hsia; Alison Marsden Journal: Ann Biomed Eng Date: 2014-09-27 Impact factor: 3.934
Authors: Thomas Deneke; Thomas Lawo; Stefan von Dryander; Peter Hubert Grewe; Alfried Germing; Eduard Gorr; Peter Hubben; Andreas Mugge; Dong-In Shin; Bernd Lemke Journal: Indian Pacing Electrophysiol J Date: 2010-02-01
Authors: Kenneth M Stein; Kenneth A Ellenbogen; Michael R Gold; Bernd Lemke; Ignacio Fernández Lozano; Suneet Mittal; Francis G Spinale; Jennifer E Van Eyk; Alan D Waggoner; Timothy E Meyer Journal: Pacing Clin Electrophysiol Date: 2009-10-10 Impact factor: 1.976
Authors: Charlotte H Manisty; Ali Al-Hussaini; Beth Unsworth; Resham Baruah; Punam A Pabari; Jamil Mayet; Alun D Hughes; Zachary I Whinnett; Darrel P Francis Journal: Circ Arrhythm Electrophysiol Date: 2011-11-17