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Cardiac Resynchronisation Therapy (CRT)—Is 100% Response Possible?
S16
Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
was corrected by CRT. In patients with DI < 34 response rates are lower, and changes in DI do not correlate to outcome. DI predicts likelihood of response to CRT, but patients with low DI scores may respond by means other than intraventricular dyssynchrony to be established.
38 Comparison of Predicted Optimal Settings of Cardiac Resynchronisation Therapy (CRT) by Different Echocardiographic Measures
doi:10.1016/j.hlc.2007.06.041
Austin Health, Heidelberg, Victoria, Australia
37 Cardiac Resynchronisation Therapy (CRT)—Is 100% Response Possible? M. Swale ∗ , H.S. O’Donnell
Lim, K.
Phillips, D.
Harbarts, D.
Austin Health, Heidelberg, Victoria, Australia Background: Reported response rates to CRT are variable, with numerous factors reported to predict response. We reviewed patients receiving CRT to correlate clinical, echocardiographic and implant variables with response rates. Methods: We reviewed 148 patients receiving CRT, evaluated clinically and with echocardiography including tissue Doppler imaging (TDI), before and after CRT. NYHA class, electrograms, ejection fraction (EF), dyssynchrony and implant characteristics were assessed. Dyssynchrony Index (DI) was assessed by standard deviation of time to peak systolic velocity in twelve myocardial segments, Interventricular mechanical delay (IVMD) by difference between LV and RV pre-ejection intervals. A subset of patients underwent DI guided optimisation of A–V and V–V timing. Response was defined using clinical (≥1 NYHA class) and echocardiographic (≥5% EF) improvement 6 months following implantation. Results: Overall response was 75%. Pre-implant predictors of success were sinus rhythm, DI > 34 and IVMD > 40 ms. Implant predictors were LV lead position (true lateral or at latest segment), and RV to LV electrogram > 80 ms in intrinsic rhythm. Post implant predictors were ventricular pacing > 95%, optimisation and DI improvement. Fifty-four patients met all predictors and 51 of these responded (optimal rate = 95%). Ninetyfour patients did not meet criteria, with 62 responding (response rate = 66%). Conclusions: Selected patients with an optimally placed LV lead represented 36% of implants with a response rate of 95%. Patients without ideal characteristics had 66% response. Optimal planning of CRT, lead placement and optimisation result in higher response rates to therapy. doi:10.1016/j.hlc.2007.06.042
M. Swale ∗ , D. Harbarts, C. McCormack, D. O’Donnell
Background: Recent data have shown benefit in symptoms and response rate with CRT by “optimising” left to right ventricular (V–V) timing using echocardiographic measures. Multiple measures exist of differing complexity, and as yet none is “gold standard”. We compare the predicted optimal V–V interval in a series of patients using three methods. Methods: We compare 40 patients with CRT implanted for standard indications, who underwent optimisation in the last year. Each had optimal settings predicted based on Aortic VTI, Interventricular Mechanical Delay (IVMD = difference between pre-ejection intervals) and Dyssynchrony Index (DI = standard deviation of time to peak systolic velocity by Tissue Doppler Imaging in 12 myocardial segments). Predicted settings were compared between categories using percentage agreement and correlation coefficient, and all three settings compared with ANOVA. Results: Comparisons between groups showed: DI versus VTI 47% agreement, (correlation coefficient 0.33); DI versus IVMD 58% agreement (coefficient 0.55), IVMD versus VTI 23% agreement (coefficient 0.05). ANOVA comparison of all three groups gave a p-value of 0.74. Conclusions: Marked variability exists between predicted optimal settings using different echocardiographic methods. Each has different time constraints and correlations to clinical outcomes, and as the methods are not predictive of each other further investigation is required to determine the optimal approach. doi:10.1016/j.hlc.2007.06.043 39 The Long-Term Ventricular Assist Device (VAD) Program in Western Australia—8 Years on C.A. Wood ∗ , L. Dembo, R. Larbalestier, G. O’Driscoll Advanced Heart Failure & Cardiac Transplant Service, Royal Perth Hospital, School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia Background: The state centre for long-term mechanical support in Western Australia is run by the Advanced Heart Failure & Transplant Service at the Royal Perth Hospital. The outpatient program was established in 1999 and has rapidly expanded to incorporate both volume displacement and rotary devices. This paper examines the program’s experiences and outlines clinical outcomes and problems, associated with differing VAD support. Methods: Forty-seven patients have been supported (42M, 5F, mean age, 44 years). Aetiologies (%); ischaemic (36), idiopathic (34), viral (4), peripartum (4), Becker’s muscular
Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
was corrected by CRT. In patients with DI < 34 response rates are lower, and changes in DI do not correlate to outcome. DI predicts likelihood of response to CRT, but patients with low DI scores may respond by means other than intraventricular dyssynchrony to be established.
38 Comparison of Predicted Optimal Settings of Cardiac Resynchronisation Therapy (CRT) by Different Echocardiographic Measures
doi:10.1016/j.hlc.2007.06.041
Austin Health, Heidelberg, Victoria, Australia
37 Cardiac Resynchronisation Therapy (CRT)—Is 100% Response Possible? M. Swale ∗ , H.S. O’Donnell
Lim, K.
Phillips, D.
Harbarts, D.
Austin Health, Heidelberg, Victoria, Australia Background: Reported response rates to CRT are variable, with numerous factors reported to predict response. We reviewed patients receiving CRT to correlate clinical, echocardiographic and implant variables with response rates. Methods: We reviewed 148 patients receiving CRT, evaluated clinically and with echocardiography including tissue Doppler imaging (TDI), before and after CRT. NYHA class, electrograms, ejection fraction (EF), dyssynchrony and implant characteristics were assessed. Dyssynchrony Index (DI) was assessed by standard deviation of time to peak systolic velocity in twelve myocardial segments, Interventricular mechanical delay (IVMD) by difference between LV and RV pre-ejection intervals. A subset of patients underwent DI guided optimisation of A–V and V–V timing. Response was defined using clinical (≥1 NYHA class) and echocardiographic (≥5% EF) improvement 6 months following implantation. Results: Overall response was 75%. Pre-implant predictors of success were sinus rhythm, DI > 34 and IVMD > 40 ms. Implant predictors were LV lead position (true lateral or at latest segment), and RV to LV electrogram > 80 ms in intrinsic rhythm. Post implant predictors were ventricular pacing > 95%, optimisation and DI improvement. Fifty-four patients met all predictors and 51 of these responded (optimal rate = 95%). Ninetyfour patients did not meet criteria, with 62 responding (response rate = 66%). Conclusions: Selected patients with an optimally placed LV lead represented 36% of implants with a response rate of 95%. Patients without ideal characteristics had 66% response. Optimal planning of CRT, lead placement and optimisation result in higher response rates to therapy. doi:10.1016/j.hlc.2007.06.042
M. Swale ∗ , D. Harbarts, C. McCormack, D. O’Donnell
Background: Recent data have shown benefit in symptoms and response rate with CRT by “optimising” left to right ventricular (V–V) timing using echocardiographic measures. Multiple measures exist of differing complexity, and as yet none is “gold standard”. We compare the predicted optimal V–V interval in a series of patients using three methods. Methods: We compare 40 patients with CRT implanted for standard indications, who underwent optimisation in the last year. Each had optimal settings predicted based on Aortic VTI, Interventricular Mechanical Delay (IVMD = difference between pre-ejection intervals) and Dyssynchrony Index (DI = standard deviation of time to peak systolic velocity by Tissue Doppler Imaging in 12 myocardial segments). Predicted settings were compared between categories using percentage agreement and correlation coefficient, and all three settings compared with ANOVA. Results: Comparisons between groups showed: DI versus VTI 47% agreement, (correlation coefficient 0.33); DI versus IVMD 58% agreement (coefficient 0.55), IVMD versus VTI 23% agreement (coefficient 0.05). ANOVA comparison of all three groups gave a p-value of 0.74. Conclusions: Marked variability exists between predicted optimal settings using different echocardiographic methods. Each has different time constraints and correlations to clinical outcomes, and as the methods are not predictive of each other further investigation is required to determine the optimal approach. doi:10.1016/j.hlc.2007.06.043 39 The Long-Term Ventricular Assist Device (VAD) Program in Western Australia—8 Years on C.A. Wood ∗ , L. Dembo, R. Larbalestier, G. O’Driscoll Advanced Heart Failure & Cardiac Transplant Service, Royal Perth Hospital, School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia Background: The state centre for long-term mechanical support in Western Australia is run by the Advanced Heart Failure & Transplant Service at the Royal Perth Hospital. The outpatient program was established in 1999 and has rapidly expanded to incorporate both volume displacement and rotary devices. This paper examines the program’s experiences and outlines clinical outcomes and problems, associated with differing VAD support. Methods: Forty-seven patients have been supported (42M, 5F, mean age, 44 years). Aetiologies (%); ischaemic (36), idiopathic (34), viral (4), peripartum (4), Becker’s muscular