Efficiency, reproducibility and agreement of five different hemodynamic measures for optimization of cardiac resynchronization therapy.
BACKGROUND
Several hemodynamic measures have been used for optimization of the AV delay of cardiac resynchronization therapy (CRT), including pulse pressure (PP), systolic blood pressure (SBP) and cardiac output (CO). We aimed to determine whether these measures identify the same optimum and whether they have the same efficiency and reproducibility at identifying this optimum.


RESULTS
In 22 patients with cardiac resynchronization therapy, we adjusted the AV delay while atrially pacing at 110 bpm and simultaneously recording SBP, diastolic blood pressure (DBP), PP, mean arterial pressure (MAP) and CO. SBP, PP and CO all had essentially the same signal-to-noise ratios (15.4+/-5.4, 15.5+/-6.4, 15.3+/-7.4 respectively p=NS). In contrast, MAP and DBP had significantly worse signal-to-noise ratios than SBP (14.2+/-5.6, p=0.003 and 12.1+/-4.4, p<0.0001 respectively). The optimal AV delay was very similar between SBP, PP, MAP and DBP. For example, the optima identified by SBP correlated strongly with those identified by PP (r=0.94), MAP (r=0.96) and DBP (r=0.90). In contrast, the optima detected by CO was poorly related to these (e.g. r=0.36 with SBP optima). Reproducibility was best for optima detected by SBP followed by MAP and PP.


CONCLUSIONS
Essentially the same AV optimum is identified, regardless of whether the parameter chosen for maximization is SBP, PP, MAP or DBP. We conclude that optimizing the CRT AV delay using SBP gives the best combination of efficiency and reproducibility, with PP and MAP being reasonable alternatives.
Whinnett
Zachary I
ZI
International Centre for Circulatory Health, St Mary's Hospital and Imperial College, 59-61 North Wharf Road, W2 1LA, London, United Kingdom.
Davies
Justin E R
JE
Nott
Gemma
G
Willson
Keith
K
Manisty
Charlotte H
CH
Peters
Nicholas S
NS
Kanagaratnam
Prapa
P
Davies
D Wyn
DW
Hughes
Alun D
AD
Mayet
Jamil
J
Francis
Darrel P
DP
D000368:Aged; D054537:Atrioventricular Block / Q000503:physiopathology / Q000628:therapy*; D001283:Atrioventricular Node / Q000503:physiopathology*; D001794:Blood Pressure; D002037:Bundle-Branch Block; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003971:Diastole; D005260:Female; D006305:Health Status Indicators; D006329:Heart Conduction System / Q000503:physiopathology*; D006334:Heart Function Tests; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013599:Systole