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Efficiency, reproducibility and agreement of five different hemodynamic measures for optimization of cardiac resynchronization therapy.

Abstract：

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. METHODS AND 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.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Whinnett ZI,Davies JE,Nott G,Willson K,Manisty CH,Peters NS,Kanagaratnam P,Davies DW,Hughes AD,Mayet J,Francis DP

doi

10.1016/j.ijcard.2007.08.004

subject

Has Abstract

pub_date

2008-09-26 00:00:00

pages

216-26

issue

2

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(07)01486-6

journal_volume

129

pub_type

杂志文章

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