Cardiac Resynchronization Therapy Optimization Using Trans Esophageal Doppler in Patients with Dilated Cardiomyopathy
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- Category: Vol. 82, March 2014
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Cardiac Resynchronization Therapy Optimization Using Trans Esophageal Doppler in Patients with Dilated Cardiomyopathy, ABDALLAH YOUSSIF, AHMED ABDELAZIZ, HAMDY M. SABER and MOHAMED E. AFIFY
Abstract
Introduction: Application of CRT remains a challenge, both from the technical aspect and optimization. Transesoph-ageal Doppler is a simple Hemodynamic monitoring technique, that my help in optimizing CRT devices.
Objectives: We investigated the utility of Trans esophageal Doppler to optimize cardiac resynchronization therapy (CRT) parameters.
Methods: Thirty patients underwent CRT implantation, baseline 2D echocardiogram (echo), 6min walk distance, and quality of life (QOL) questionnaire within 1 week of implant. Following implant, 15 patients (group A) had their CRT, CRTD device A-V delay and V-V delay optimized using trans esophageal Doppler. Optimal parameters were programmed. 15 patients (group B) were left with fixed AV delay 120ms and fixed VV delay 0ms. Echo, 6min walk, and QOL were repeated at 3-6 months post-implant.
Results: All parameters showed a significant improvement at follow-up when compared to baseline for whole study population, in comparison of the degree of improvement in both groups to each other, group A showed a statistically significant improvement at follow-up in LVED percentage of improvement compared to group B (11.9%±11% vs 1.5%±6.5% p-value 0.004). Also in the measurements of LVES & EF % (5.15cm±0.9cm & 38.5%±9% for group A versus 5.9cm±0.9cm & 31.4%±8.8% for group B, (p-value 0.03 & 0.04 respectively). Although comparing the degree of improvement in clinical parameters in both groups did not show any statistically significant difference in QOL (41.6±21.46 vs 50.67±20.19, respectivly) or in six minute walk test (358.67±131.4 vs 265.87±126.2 respectively).
Conclusion: We can conclude that using the Transesoph-ageal Doppler for optimization of CRT devices can only improve some of the Echo parameters with no impact on clinical parameters.