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Is CRT Optimization Obsolete? A Referral Center's Experience
Shmaila Saleem-Talib1, Mirjam D Duineveld1, Jurjan C Schipper2
1Department of Cardiology, Haga Teaching Hospital, 2545 AA The Hague, The Netherlands.
Insights
Cardiac resynchronization therapy (CRT) optimization using echocardiography significantly improves heart failure outcomes. This method enhances left ventricular ejection fraction and New York Heart Association class in patients who did not initially respond to CRT.
Area of Science:
- Cardiology
- Medical Devices
- Echocardiography
Background:
- Cardiac resynchronization therapy (CRT) is a standard treatment for heart failure (HF).
- A significant portion of HF patients (30%) do not benefit from CRT.
- A need exists for improved CRT optimization strategies.
Purpose of the Study:
- To report an echocardiography-based methodology for optimizing CRT.
- To evaluate the effectiveness of this optimization technique in a real-world clinical setting.
Main Methods:
- A cohort of 350 ambulatory HF patients referred for CRT optimization was studied.
- A protocol-driven echocardiographic approach was used to adjust ventriculoventricular (VV) and atrioventricular (AV) delays.
- Left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) class changes were primary outcome measures.
Main Results:
- Successful optimization was achieved in 82% of patients (288/350).
- Adjustments to VV and AV timings were made, with mean values of 61% and 51%, respectively.
- Significant improvements in LVEF and NYHA class were observed in all optimized patients.
Conclusions:
- Echocardiography-based CRT optimization is a valuable strategy.
- This method effectively improves LVEF and functional status (NYHA class) in HF patients.
- CRT optimization enhances outcomes for patients receiving CRT devices.
Background:
Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with heart failure (HF). However, 30% of HF patients do not show any improvement in clinical status after CRT implantation. In this study, we report our echocardiography-based CRT optimization methodology, in daily practice at our CRT referral center.
Methods:
We included 350 ambulatory patients, who were referred to our center for optimization after CRT implantation. A protocol-driven echocardiographic approach for adjusting mechanical dyssynchrony, whereby adjusting for ventriculoventricular (VV) delays with strain and atrioventricular (AV) delays with Doppler echocardiography was performed. We defined changes in left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) classes as outcome variables in the evaluation of the CRT outcomes.
Results:
Optimization was obtained in 288 (82%) patients. VV and AV timings were adjusted to 61% and 51%, respectively. In 3%, biventricular pacing was turned off and in 3% left ventricular (LV) only pacing was programmed. The LVEF and NYHA class showed significant improvements in all patients who underwent CRT optimization.
Conclusions:
CRT optimization remains valuable in improving LVEF and functional status measured using the NYHA class in all patients receiving CRT devices.
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