PMID- 21797899
OWN - NLM
STAT- MEDLINE
DCOM- 20120424
LR  - 20120201
IS  - 1540-8159 (Electronic)
IS  - 0147-8389 (Linking)
VI  - 34
IP  - 11
DP  - 2011 Nov
TI  - Cardiac resynchronization therapy optimization using noninvasive cardiac output 
      measurement.
PG  - 1527-36
LID - 10.1111/j.1540-8159.2011.03172.x [doi]
AB  - AIMS: Noninvasive cardiac output (CO) measurement (NICOM) is a novel method to 
      assess ventricular function and offers a potential alternative for optimization 
      of cardiac resynchronization therapy (CRT) devices. We compared the effect of 
      NICOM-based optimization to no optimization (empiric settings) on CRT outcomes. 
      METHODS: Two hundred and three patients undergoing CRT were assessed in two 
      consecutive nonrandomized groups; an empiric group (n = 54) was programmed to 
      "out of the box" settings with a fixed AV delay of 120 ms and a VV delay of 0 ms; 
      and the optimization group (n = 149) underwent adjustments of both the AV and VV 
      delays according to the greatest improvement in resting CO. The primary endpoints 
      were improvements in left ventricular (LV) volumes and function from baseline at 
      6 months. Secondary endpoints were change in New York Heart Association (NYHA) 
      class, quality of life score, and 6-minute walk test (6 MWT) performance. 
      RESULTS: After 6 months of CRT, the optimization group had a better clinical 
      response with lower NYHA class (2.1 +/- 0.8 vs 2.4 +/- 0.8, P = 0.048) and quality of 
      life scores (35 +/- 18 vs 42 +/- 20, P = 0.045) but no differences in 6-MWT 
      performance (269 +/- 110 vs 277 +/- 114 m, P = 0.81). Echocardiographic response was 
      also better in the optimization group with lower LV end systolic volume (108 +/- 51 
      vs 126 +/- 60 mL, P = 0.048) and higher ejection fraction (30 +/- 7 vs 27 +/- 8, P = 
      0.01) compared to empiric settings. CONCLUSION: Device optimization using 
      noninvasive measures of CO is associated with better clinical and 
      echocardiographic response compared to empiric settings.
FAU - Khan, Fakhar Z
AU  - Khan FZ
AD  - Department of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK.
FAU - Virdee, Munmohan S
AU  - Virdee MS
FAU - Hutchinson, John
AU  - Hutchinson J
FAU - Smith, Beverley
AU  - Smith B
FAU - Pugh, Peter J
AU  - Pugh PJ
FAU - Read, Philip A
AU  - Read PA
FAU - Fynn, Simon P
AU  - Fynn SP
FAU - Dutka, David P
AU  - Dutka DP
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
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  - Cardiography, Impedance/*methods
MH  - Female
MH  - Heart Failure/complications/*diagnosis/*prevention & control
MH  - Humans
MH  - Male
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/complications/*diagnosis/*prevention & control
EDAT- 2011/07/30 06:00
MHDA- 2012/04/25 06:00
CRDT- 2011/07/30 06:00
PHST- 2011/07/30 06:00 [entrez]
PHST- 2011/07/30 06:00 [pubmed]
PHST- 2012/04/25 06:00 [medline]
AID - 10.1111/j.1540-8159.2011.03172.x [doi]
PST - ppublish
SO  - Pacing Clin Electrophysiol. 2011 Nov;34(11):1527-36. doi: 
      10.1111/j.1540-8159.2011.03172.x.