Efficiency, reproducibility and agreement of five different hemodynamic measures for optimization of cardiac resynchronization therapy

• Published in: International journal of cardiology 2008-09, Vol.129 (2), p.216-226
• Main Authors: Whinnett, Zachary I, Davies, Justin E.R, Nott, Gemma, Willson, Keith, Manisty, Charlotte H, Peters, Nicholas S, Kanagaratnam, Prapa, Davies, D. Wyn, Hughes, Alun D, Mayet, Jamil, Francis, Darrel P
• Format: Article
• Language: English
• Subjects: Aged; Atrioventricular Block - physiopathology; Atrioventricular Block - therapy; Atrioventricular delay optimization; Atrioventricular Node - physiopathology; Biological and medical sciences; Blood Pressure; Bundle-Branch Block; Cardiac Output; Cardiac Pacing, Artificial - methods; Cardiac resynchronization therapy; Cardiology. Vascular system; Cardiovascular; Diastole; Female; Finometer; Health Status Indicators; Heart Conduction System - physiopathology; Heart Function Tests; Hemodynamic optimization; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reproducibility of Results; Systole
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2007.08.004

Abstract Background Several hemodynamic measures have been used for optimization of the AV delay of cardiac resynchronization therapy (CRT), including pulse pressure (PP), systolic blood pressure (SBP) and cardiac output (CO). We aimed to determine whether these measures identify the same optimum and whether they have the same efficiency and reproducibility at identifying this optimum. Methods and results In 22 patients with cardiac resynchronization therapy, we adjusted the AV delay while atrially pacing at 110 bpm and simultaneously recording SBP, diastolic blood pressure (DBP), PP, mean arterial pressure (MAP) and CO. SBP, PP and CO all had essentially the same signal-to-noise ratios (15.4 ± 5.4, 15.5 ± 6.4, 15.3 ± 7.4 respectively p = NS). In contrast, MAP and DBP had significantly worse signal-to-noise ratios than SBP (14.2 ± 5.6, p = 0.003 and 12.1 ± 4.4, p < 0.0001 respectively). The optimal AV delay was very similar between SBP, PP, MAP and DBP. For example, the optima identified by SBP correlated strongly with those identified by PP ( r = 0.94), MAP ( r = 0.96) and DBP ( r = 0.90). In contrast, the optima detected by CO was poorly related to these (e.g. r = 0.36 with SBP optima). Reproducibility was best for optima detected by SBP followed by MAP and PP. Conclusions Essentially the same AV optimum is identified, regardless of whether the parameter chosen for maximization is SBP, PP, MAP or DBP. We conclude that optimizing the CRT AV delay using SBP gives the best combination of efficiency and reproducibility, with PP and MAP being reasonable alternatives.