Cor Vasa 2013, 55(4):e293-e300 | DOI: 10.1016/j.crvasa.2013.07.002

Optimization of cardiac resynchronization therapy in non-responders

Milan Sepši^a,*, Lubomír Křivan^a, Milan Kozák^a, Marek Šebo^a, Martin Poloczek^a, Jiří Jarkovský^b, Lukáš Rybka^a, Lenka Kubková^a, Jitka Vlašínová^a, Jindřich Špinar^a

^a Interní kardiologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno, Česká republika

^b Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty Masarykovy univerzity, Brno, Česká republika

Background: Cardiac resynchronization therapy plays important role in treatment of heart failure patients with low left ventricular ejection fraction. However, a significant number of patients do not improve after implantation. Optimization of atrioventricular and interventricular delay could improve clinical status of these patients.

Objectives: The purpose of this study was to compare optimization of atrioventricular (AV) and interventricular (VV) delays with aortic velocity-time integral (VTI) and with maximal value of the first derivative of a left ventricular pressure signal (LVdP/dtmax).

Methods: Fifteen non-responders were optimized with aortic VTI method and QuickOpt. After 3 months the follow up echocardiography and clinical evaluation were done. Ten non-responders were optimized with LVdP/dtmax and QuickOpt. After 3 month follow up echocardiography and clinical evaluation were done.

Results: In the first group of patients (age 74.3 years [65.3, 84.3], 83.4% male, etiology: 66% ischemic heart disease, NYHA class before optimization III 66.7%, III-IV 33.3%, LVEF 23.0% [15.0; 32.0]), no correlation between AV and VV delays setting obtained from aortic VTI and QuickOpt was found. Optimization generated shorter QRS complex. After 3 months of follow up, there was no change in echo parameters or NYHA class. In the second group of patients (age 76.7 years [66.6, 82.4], 90% male, etiology: 60% ischemic heart disease, NYHA class before optimization III 50%, III-IV 50%, LVEF 29.5% [10.0; 35.0]), no correlation between AV and VV delays setting obtained from LVdP/dtmax and QuickOpt was found. Optimization in this group of patients also generated shorter QRS complex. After 3 months, increase in LVEF was observed, but other echo parameters and NYHA class remained unchanged.

Conclusion: Using aortic VTI guided optimization in CRT devices did not bring any profit for non-responder patients. Echocardiography parameters and NYHA status did not change in 3 month follow up. Using invasive LVdP/dtmax leads to a change in left ventricular ejection fraction, but NYHA class remains unchanged.

Keywords: Cardiac resynchronization therapy; Chronic heart failure; Echocardiography; Hemodynamics; Optimization

Received: January 3, 2013; Revised: July 2, 2013; Accepted: July 3, 2013; Published: August 1, 2013  Show citation