title: Comparison of hemodynamic versus dyssynchrony assessment for interventricular delay optimization with echocardiography in cardiac resynchronization therapy.
abstract: BACKGROUND
  Best practice for cardiac resynchronization therapy (CRT) device optimization is not established. This study compared Tissue Doppler Imaging (TDI) to study left ventricular (LV) synchrony and left ventricular outflow tract velocity-time integral (LVOT VTI) to assess hemodynamic performance.
  
  
  METHODS
  LVOT VTI and LV synchrony were tested in 50 patients at three interventricular (VV) delays (LV preactivation at -30 ms, simultaneous biventricular pacing, and right ventricular preactivation at +30 ms), selecting the highest VTI and the greatest degree of superposition of the displacement curves, respectively, as the optimum VV delay.
  
  
  RESULTS
  In 39 patients (81%), both techniques agreed (Kappa = 0.65, p < 0.0001) on the optimum VV delay. LV preactivation (VV - 30) was the interval most frequently chosen.
  
  
  CONCLUSIONS
  Both TDI and LVOT VTI are useful CRT programming methods for VV optimization. The best hemodynamic response correlates with the best synchrony. In most patients, the optimum VV interval is LV preactivation.
authors: Thorax Clinic Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: Adelina
authors: A
authors: Doltra
authors: Bàrbara
authors: B
authors: Vidal
authors: Etelvino
authors: E
authors: Silva
authors: Lluís
authors: L
authors: Mont
authors: David
authors: D
authors: Tamborero
authors: María Ángeles
authors: MÁ
authors: Castel
authors: José María
authors: JM
authors: Tolosana
authors: Antonio
authors: A
authors: Berruezo
authors: Josep
authors: J
authors: Brugada
authors: Marta
authors: M
authors: Sitges
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D018619:Echocardiography, Doppler, Pulsed / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*