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PROGNOSTIC VALUE OF ECHO-DOPPLER GUIDED AV DELAY OPTIMIZATION FOLLOWING CARDIAC RESYNCHRONIZATION THERAPY
1491 JACC April 5, 2016 Volume 67, Issue 13
Heart Failure and Cardiomyopathies PROGNOSTIC VALUE OF ECHO-DOPPLER GUIDED AV DELAY OPTIMIZATION FOLLOWING CARDIAC RESYNCHRONIZATION THERAPY Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Heart Failure and Cardiomyopathies: Cardiac Resynchronization Therapy Abstract Category: 27. Heart Failure and Cardiomyopathies: Therapy Presentation Number: 1218-072 Authors: Srikanth Koneru, Zoran Popovic, Paul Cremer, Patrick Tchou, Bruce Wilkoff, Bruce Lindsay, Brian Griffin, Richard Grimm, Cleveland Clinic, Cleveland, OH, USA
Background: The utility of Atrio-Ventricular (AV) delay optimization following Cardiac Resynchronization Therapy (CRT) remains unclear. We aimed to determine the utility and outcome of interrogating and selectively optimizing AV synchrony using Echo-Doppler-Guided (EDG) AV optimization following CRT. Methods: All patients undergoing CRT and an EDG AV optimization at Cleveland Clinic were included (2002 to 2014). Mitral inflow and AV delay timing was interrogated and optimized (those with stage II or III DD), targeting stage I diastolic dysfunction (DD). Mortality data was obtained from the SSDI and EMR. Results: Of 2,370 patients, 69% were men, and mean age was 65.4 yrs. Stage-I DD was present in 1,272 pts (53.7%) at baseline, and were maintained at their empiric derived AV delay setting, and realized a mortality rate of 20.8% at an average 5.3 years. In 1098 pts with stage II or Stage -III DD, 140 (12.8%) pts demonstrated improvement of > 1 diastolic function stage after EDG AV optimization. Patients converting to stage I DD from stage II or stage III DD after EDG AV had reduced mortality 29% vs 39.5% (p-0.03) compared to pts without change in diastolic function stage. Finally, patients with Stage I DD (baseline + EDG AV) have significant survival benefit compared to final Stage II or Stage III DD (0.0001), (Figure).
Conclusions: Patients with stage I DD by Echo-Guided AV delay-hemodynamic interrogation and selective optimization following CRT had an improved survival as compared to those with stage II or stage III DD.
Heart Failure and Cardiomyopathies PROGNOSTIC VALUE OF ECHO-DOPPLER GUIDED AV DELAY OPTIMIZATION FOLLOWING CARDIAC RESYNCHRONIZATION THERAPY Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Heart Failure and Cardiomyopathies: Cardiac Resynchronization Therapy Abstract Category: 27. Heart Failure and Cardiomyopathies: Therapy Presentation Number: 1218-072 Authors: Srikanth Koneru, Zoran Popovic, Paul Cremer, Patrick Tchou, Bruce Wilkoff, Bruce Lindsay, Brian Griffin, Richard Grimm, Cleveland Clinic, Cleveland, OH, USA
Background: The utility of Atrio-Ventricular (AV) delay optimization following Cardiac Resynchronization Therapy (CRT) remains unclear. We aimed to determine the utility and outcome of interrogating and selectively optimizing AV synchrony using Echo-Doppler-Guided (EDG) AV optimization following CRT. Methods: All patients undergoing CRT and an EDG AV optimization at Cleveland Clinic were included (2002 to 2014). Mitral inflow and AV delay timing was interrogated and optimized (those with stage II or III DD), targeting stage I diastolic dysfunction (DD). Mortality data was obtained from the SSDI and EMR. Results: Of 2,370 patients, 69% were men, and mean age was 65.4 yrs. Stage-I DD was present in 1,272 pts (53.7%) at baseline, and were maintained at their empiric derived AV delay setting, and realized a mortality rate of 20.8% at an average 5.3 years. In 1098 pts with stage II or Stage -III DD, 140 (12.8%) pts demonstrated improvement of > 1 diastolic function stage after EDG AV optimization. Patients converting to stage I DD from stage II or stage III DD after EDG AV had reduced mortality 29% vs 39.5% (p-0.03) compared to pts without change in diastolic function stage. Finally, patients with Stage I DD (baseline + EDG AV) have significant survival benefit compared to final Stage II or Stage III DD (0.0001), (Figure).
Conclusions: Patients with stage I DD by Echo-Guided AV delay-hemodynamic interrogation and selective optimization following CRT had an improved survival as compared to those with stage II or stage III DD.