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Cardiac Resynchronization Therapy Optimization Using Noninvasive Cardiac Output Measurement
Author(s) -
KHAN FAKHAR Z.,
VIRDEE MUNMOHAN S.,
HUTCHINSON JOHN,
SMITH BEVERLEY,
PUGH PETER J.,
READ PHILIP A.,
FYNN SIMON P.,
DUTKA DAVID P.
Publication year - 2011
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2011.03172.x
Subject(s) - medicine , cardiac resynchronization therapy , ejection fraction , cardiology , heart failure , clinical endpoint , cardiac function curve , quality of life (healthcare) , randomized controlled trial , nursing
Aims: Noninvasive cardiac output (CO) measurement (NICOM) is a novel method to assess ventricular function and offers a potential alternative for optimization of cardiac resynchronization therapy (CRT) devices. We compared the effect of NICOM‐based optimization to no optimization (empiric settings) on CRT outcomes.Methods: Two hundred and three patients undergoing CRT were assessed in two consecutive nonrandomized groups; an empiric group (n = 54) was programmed to “out of the box” settings with a fixed AV delay of 120 ms and a VV delay of 0 ms; and the optimization group (n = 149) underwent adjustments of both the AV and VV delays according to the greatest improvement in resting CO. The primary endpoints were improvements in left ventricular (LV) volumes and function from baseline at 6 months. Secondary endpoints were change in New York Heart Association (NYHA) class, quality of life score, and 6‐minute walk test (6 MWT) performance.Results: After 6 months of CRT, the optimization group had a better clinical response with lower NYHA class (2.1 ± 0.8 vs 2.4 ± 0.8, P = 0.048) and quality of life scores (35 ± 18 vs 42 ± 20, P = 0.045) but no differences in 6‐MWT performance (269 ± 110 vs 277 ± 114 m, P = 0.81). Echocardiographic response was also better in the optimization group with lower LV end systolic volume (108 ± 51 vs 126 ± 60 mL, P = 0.048) and higher ejection fraction (30 ± 7 vs 27 ± 8, P = 0.01) compared to empiric settings.Conclusion: Device optimization using noninvasive measures of CO is associated with better clinical and echocardiographic response compared to empiric settings. (PACE 2011; 34:1527–1536)