CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC 2022 18_5-6_13910.15836/ccar2023.139Extended AbstractAdditional benefit of echocardiographic optimization of cardiac resynchronization therapy devices according to specific echocardiographic and clinical parametershttps://orcid.org/0000-0003-1542-2890BrestovacMarija*https://orcid.org/0000-0003-1134-4856Glavaš KonjaBlankahttps://orcid.org/0000-0001-8446-6120Lovrić BenčićMartinahttps://orcid.org/0000-0002-4721-3236Rešković LukšićVlatkahttps://orcid.org/0000-0002-7349-6137Jakšić JurinjakSandrahttps://orcid.org/0000-0002-1482-6503BulumJoškohttps://orcid.org/0000-0003-1762-9270OstojićZvonimirhttps://orcid.org/0000-0002-1191-4831GašparovićKristinahttps://orcid.org/0000-0002-3437-6407Šeparović HanževačkiJadrankaUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, CroatiaADDRESS FOR CORRESPONDENCE: Marija Brestovac, Klinički bolnički centar Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia. / Phone: +385-99-7742-627 / E-mail: marija.brestovac@gmail.com042023185-613913925032023290320232023Croatian Cardiac SocietyKEYWORDS: cardiac resynchronization therapy optimizationechocardiographic optimizationmyocardial dyssynchrony
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.
LITERATUREGallardABidautAHubertASadeEMarechauxSSitgesMCharacterization of Responder Profiles for Cardiac Resynchronization Therapy through Unsupervised Clustering of Clinical and Strain Data.J Am Soc Echocardiogr. 2021 May;34(5):483–93. 10.1016/j.echo.2021.01.01933524492StephansenCKronborgMBWittCTKristensenJGerdesCSommerAReproducibility of measuring QRS duration and implications for optimization of interventricular pacing delay in cardiac resynchronization therapy.Ann Noninvasive Electrocardiol. 2019 May;24(3):e12621. 10.1111/anec.1262130521128van der BijlPKhidirMAjmone MarsanNDelgadoVLeonMBStoneGWEffect of Functional Mitral Regurgitation on Outcome in Patients Receiving Cardiac Resynchronization Therapy for Heart Failure.Am J Cardiol. 2019 January 1;123(1):75–83. 10.1016/j.amjcard.2018.09.02030539749CalleSDelensCKamoenVDe PooterJTimmermansF. Septal flash: At the heart of cardiac dyssynchrony.Trends Cardiovasc Med. 2020 February;30(2):115–22. 10.1016/j.tcm.2019.03.00831000325