Premium
Three‐Dimensional Echocardiographic Optimization Improves Outcome in Cardiac Resynchronization Therapy Compared to ECG Optimization: A Randomized Comparison
Author(s) -
SONNE CAROLIN,
BOTTFLUGEL LORENZ,
HAUCK SIMON,
HADAMITZKY MARTIN,
LESEVIC HASEMA,
DEMETZ GABRIELE,
BRAUN DANIEL,
WOLF PETRA,
HAUSLEITER JÖRG,
SCHÖMIG ALBERT,
KOLB CHRISTOF
Publication year - 2014
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/pace.12281
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , ejection fraction , qrs complex , clinical endpoint , heart failure , randomized controlled trial , confidence interval
Aims There is little consensus on optimal atrioventricular (AV) and ventricular‐to‐ventricular (VV) intervals in cardiac resynchronization therapy (CRT). The aim of this study was to examine a novel combination of Doppler echocardiography (DE) and three‐dimensional echocardiography (3DE) for individualized AV‐ and VV‐interval optimization compared to conventional electrocardiogram (ECG) optimization. Methods In this double‐blind, randomized controlled trial, 77 patients (male: 57, age: 68 ± 10 years) with severely reduced ejection fraction (EF), New York Heart Association (NYHA) class III or IV, and wide QRS complex (>120 ms) have been included. Patients were randomized to either AV‐ and VV‐interval optimization using DE and 3DE (group 1, n = 39) or ECG (group 2, n = 38). 3DE was performed in all patients for the evaluation of left ventricular (LV) dimensions, EF and systolic dyssynchrony index (SDI), and NYHA class obtained before CRT and after 3 months. Primary endpoint of the study was clinical response to CRT, defined as a reduction of NYHA class by ≥1 score. Secondary endpoints were change of EF, LV volumes, and SDI. Results There were significantly more responders in group 1 (82%) than in group 2 (58%, P = 0.021). Similarly, group 1 showed a larger increase in EF (7.0 ± 6.0% vs 3.4 ± 5.6%, P = 0.015) and a more pronounced reduction of SDI (–4.5 ± 5.9% vs –1.5 ± 5.6%, P = 0.039) than group 2. Conclusion Compared with conventional ECG optimization, this novel echocardiographic optimization protocol resulted in a significantly higher response rate, improved LV systolic function, and may be used to select the optimal AV and VV intervals in CRT.