Compari̇son of doppler echocardiographic and invasive hemodynamic methods for opti̇mi̇zati̇on of patients receiving kardiak resynchronization therapy

COMPARİSON OF DOPPLER ECHOCARDIOGRAPHIC AND INVASIVE HEMODYNAMIC METHODS FOR OPTİMİZATİON OF PATIENTS RECEIVING KARDIAK RESYNCHRONIZATION THERAPY Cardiac resynchronization therpy (CRT) is a novel therapy for patients with heart failure. Pacemaker optimization has favorable effects on patients who are poor responders to CRT. We aimed to compare acute and mid-term effects of invasive and echocardiographic optimization methods on hemodynamic and volume response after CRT. In this prospective, clinical trial, to compare invasive and echocardiographic methods for atrioventricular (AV) and ventriculoventricular (VV) delay programming we randomized patients to either echocardiographic (n=20) or invasive method (n=20). AV delays from 60 to 160 ms, VV delays from -60 to +60 were tested by both methods in all patients initially, then the patients were randomly assigned to either invasive or echocardigraphy results for follow-up. Optimal AV and VV delays were defined as the ones that yielded the largest left ventricular outflow tract time velocity integral (LVOT-TVI) and diastolic filling time (DFT) by echocardiography and the largest LV dP/dtmax by invasive method. End systolic volume (ESV) decrease ≥15% and absolute ejection fraction (EF) increase >5% were considered as significant volume response, NYHA class increase ≥1 as clinical response at 6 months. Initially determined optimal AV delays were concordant in 57.5% of patients within ±10 ms, and VV delays were concordant in 65% of patients within ±20 ms. We observed significant improvement in acute hemodynamic response by echo-guided optimization (improvement in DFT: from 360±123 ms to 467±137 ms; p<0.001, and LVOT-TVI: from 13.5±4 cm to 16±4.4 cm ; p<0.001 ) and by invasive optimization (improvement in LV dP/dtmax: from 1088±327 dynes/s to 1336±327 dynes/s; p=<0.001). At 6 months, by invasive optimization 70% of patients were clinical responders, 40% were volume responders, 70% were EF responders, and by echo-guided optimization these ratios were 45%, 60%, 60% respectively (p=NS). Optimization method did not predict clinical or volume response at 6 months. In conclusion, both invasive hemodynamic and echocardiographic Doppler methods are comparable and effective for CRT optimization. Key words; Heart Failure, Cardiac Resynchronization Therapy, Optimization