PMID- 20663072
OWN - NLM
STAT- MEDLINE
DCOM- 20110201
LR  - 20100930
IS  - 1540-8159 (Electronic)
IS  - 0147-8389 (Linking)
VI  - 33
IP  - 10
DP  - 2010 Oct
TI  - Iterative cardiac output measurement for optimizing cardiac resynchronization 
      therapy: a randomized, blinded, crossover study.
PG  - 1188-94
LID - 10.1111/j.1540-8159.2010.02848.x [doi]
AB  - BACKGROUND: Many invasive and noninvasive methods have been proposed for guiding 
      optimal programming of cardiac resynchronization therapy (CRT) devices. However, 
      results are not satisfying. Preliminary results suggest that cardiac output (CO) 
      measurements using inert gas rebreathing (IGR) might be an eligible method to 
      tailor atrioventricular (AV) and ventriculo-ventricular (VV) programming. The 
      aims of the present study were: (1) to evaluate whether an optimization of CRT 
      can be obtained by noninvasive CO measurements and (2) to evaluate whether acute 
      hemodynamic improvements obtained by this approach relate into increase in 
      cardiac exercise capacity. METHODS: In 24 patients on CRT, iterative VV- and 
      AV-delay optimization was done using the IGR method. This blinded, randomized, 
      crossover study compared the responses to optimization during two periods: a 
      4-week optimized and a 4-week standard programming. Exercise capacity after 
      optimization was assessed after each period by New York Heart Association (NYHA) 
      classification, a 6-minute walking test, and quality of life (QoL) questionnaire. 
      RESULTS: CO could be determined by IGR in all patients. The NYHA class decreased 
      by 17.8% (2.8 +/- 0.3 vs 2.3 +/- 0.4, P < 0.001), the mean (+/- standard deviation) 
      distance walked in 6 minutes was 9.3% greater after optimization (456 +/- 140 m vs 
      417 +/- 134 m, P < 0.001), and the QoL improved by 14.5% (41.8 +/- 10.4 vs 36.5 +/- 
      9.5, P < 0.001). The portion of responders to CRT increased from 66.5% to 87.5%. 
      CONCLUSION: CRT optimization by iterative CO measurements leads to an increase in 
      CO and an improvement of exercise capacity. Our results suggest that this method 
      might become an important additive tool to adjust CRT programming.
CI  - (c)2010, The Authors. Journal compilation (c)2010 Wiley Periodicals, Inc.
FAU - Reinsch, Nico
AU  - Reinsch N
AD  - West-German Heart Centre Essen, Department of Cardiology, University of 
      Duisburg-Essen, Hufelandstrasse 55, Essen, Germany. nico.reinsch@uk-essen.de
FAU - Konorza, Thomas
AU  - Konorza T
FAU - Woydowski, Dagmar
AU  - Woydowski D
FAU - Bruck, Heike
AU  - Bruck H
FAU - Volsek, Michaela
AU  - Volsek M
FAU - Muller-Tasch, Thomas
AU  - Muller-Tasch T
FAU - Neumann, Till
AU  - Neumann T
FAU - Erbel, Raimund
AU  - Erbel R
FAU - Wieneke, Heinrich
AU  - Wieneke H
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Pacing Clin Electrophysiol
JT  - Pacing and clinical electrophysiology : PACE
JID - 7803944
SB  - IM
MH  - Aged
MH  - *Cardiac Output
MH  - Cardiac Resynchronization Therapy/*methods
MH  - *Cardiac Resynchronization Therapy Devices
MH  - Cross-Over Studies
MH  - Exercise
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Quality of Life
MH  - Stroke Volume
MH  - Walking
EDAT- 2010/07/29 06:00
MHDA- 2011/02/02 06:00
CRDT- 2010/07/29 06:00
PHST- 2010/07/29 06:00 [entrez]
PHST- 2010/07/29 06:00 [pubmed]
PHST- 2011/02/02 06:00 [medline]
AID - PACE2848 [pii]
AID - 10.1111/j.1540-8159.2010.02848.x [doi]
PST - ppublish
SO  - Pacing Clin Electrophysiol. 2010 Oct;33(10):1188-94. doi: 
      10.1111/j.1540-8159.2010.02848.x.