Is CRT Optimization Obsolete? A Referral Center’s Experience

Reviews in Cardiovascular Medicine Pub Date : 2024-02-18 DOI:10.31083/j.rcm2502063

S. Saleem-Talib, Mirjam D. Duineveld, J. C. Schipper, Arnaud D. Hauer, Hemanth Ramanna, Natasja M. S. de Groot, Michael G. Scheffer

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Abstract

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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显像管优化是否已经过时？转诊中心的经验

背景：心脏再同步化疗法（CRT）是治疗心力衰竭（HF）患者的一种行之有效的疗法。然而，30% 的心衰患者在植入 CRT 后临床状况没有任何改善。在本研究中，我们报告了我们的 CRT 转诊中心在日常实践中采用的基于超声心动图的 CRT 优化方法。方法：我们纳入了 350 名门诊患者，他们在植入 CRT 后被转诊到本中心接受优化治疗。我们采用了一种协议驱动的超声心动图方法来调整机械不同步，即通过应变来调整心室（VV）延迟，通过多普勒超声心动图来调整房室（AV）延迟。我们将左室射血分数（LVEF）和纽约心脏协会（NYHA）分级的变化定义为评估 CRT 效果的结果变量。结果：288 例（82%）患者获得了优化。VV和AV定时调整率分别为61%和51%。3%的患者关闭了双心室起搏，3%的患者只进行了左心室起搏。所有接受 CRT 优化的患者的 LVEF 和 NYHA 分级均有显著改善。结论：在所有接受 CRT 设备治疗的患者中，CRT 优化在改善 LVEF 和使用 NYHA 分级测量的功能状态方面仍有价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Reviews in Cardiovascular Medicine

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