Acute alterations in left ventricular structure and mechanics following Interventricular CRT optimisation.
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All Authors
Peters, R.
Partheban, M.
Abdul Samad, N.H.
Paton, M.F.
LTHT Author
Peters, Rhiannon
Paton, Maria
Paton, Maria
LTHT Department
Cardio-Respiratory
Cardiology
Cardiology
Non Medic
Specialist Cardiac Physiologist
Highly Specialist Cardiac Physiologist
Highly Specialist Cardiac Physiologist
Publication Date
2025
Item Type
Conference Abstract
Language
Subject
CARDIAC PACING, ARTIFICIAL , PACEMAKER, ARTIFICIAL , CONTROLLED CLINICAL TRIALS AS TOPIC , DIAGNOSIS , ECHOCARDIOGRAPHY , HEART FAILURE , HEART FUNCTION TESTS , HEART , HEART VENTRICLES , REPRODUCIBILITY OF RESULTS , BLOOD PRESSURE
Subject Headings
Abstract
Background: Cardiac resynchronisation therapy (CRT) is a well-established treatment for patients with left ventricular (LV) systolic dysfunction and ventricular conduction delay. Individualised optimisation has been shown to improve CRT response rates. Non-invasive myocardial work (MW) quantification is an emerging echocardiographic measure which overcomes some limitations of traditional imaging markers of cardiac function as it is somewhat adjusted for loading factors, hence may be a useful in driving CRT optimisation. Aim(s): To assess LV size, function, and MW parameters at varying V-V offset intervals during CRT device optimisation. Method(s): A service evaluation was conducted with data from 10 patients attending the combined heart failure and device (CHAD) clinic at a single tertiary centre. CRT optimisation included altering V-V offsets as standard care. Echocardiographic images were obtained for each V-V configuration 1 min after reprogramming and were used to calculate LV end diastolic and systolic volumes, ejection fraction (EF), and MW. The primary outcome was within-patient differences in cardiac size and function across V-V intervals. Result(s): No statistically significant within-patient differences were observed in LV size or function acutely following V-V reprogramming. A non-significant increase in Global Work Index was observed for left-right interventricular programming (p = 0.84). Intra-observer agreement was excellent (ICC > 0.90, p < 0.05) for all MW parameters, except for Global Wasted Work (ICC = 0.36, p = 0.22) (Table 1). Conclusion(s): Quantification of echocardiographic measurements during CRT optimisation is feasible and reproducible. There are limited measurable acute changes in LV size or global function to direct interventricular delay optimisation, although, MW index may have the potential to provide useful data and may indicate left to right configurations are beneficial in most patients.
Journal
Echo Research and Practice