Hemodynamic benefit of rest and exercise optimization of cardiac resynchronization therapy

Stanton, Tony, Haluska, Brian A., Leano, Rodel and Marwick, Thomas H. (2014) Hemodynamic benefit of rest and exercise optimization of cardiac resynchronization therapy. Echocardiography, 31 8: 980-988. doi:10.1111/echo.12506

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Author Stanton, Tony
Haluska, Brian A.
Leano, Rodel
Marwick, Thomas H.
Title Hemodynamic benefit of rest and exercise optimization of cardiac resynchronization therapy
Journal name Echocardiography   Check publisher's open access policy
ISSN 0742-2822
Publication date 2014-01-22
Sub-type Article (original research)
DOI 10.1111/echo.12506
Open Access Status
Volume 31
Issue 8
Start page 980
End page 988
Total pages 9
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell Publishing
Collection year 2015
Language eng
Formatted abstract
The optimal method of cardiac resynchronization therapy (CRT) optimization is as yet unknown. We sought to investigate the responses of optimization at rest and on exercise. This 2 stage study involved 59 patients (age 65 ± 10, 75% male), who had all recently undergone successful CRT implantation. In the first stage, the 6-month response was compared between 30 individuals who underwent resting echocardiographic optimization of CRT [atrioventricular (AV delay) plus ventriculo-ventricular delays (VV delay)], compared with the 29 who did not. In the second stage, a subset of 37 patients from the original cohort were randomized (double-blind) to either resting echocardiographic optimization (n = 20) or exercise echocardiographic optimization (n = 17) and followed for a further 6 months. Clinical and echocardiographic data were collected at each stage. Patients undergoing rest optimization demonstrated improvement in almost all variables and significantly in B-type natriuretic peptide (BNP) in contrast to those without optimization. In a linear regression model, the only significant predictor of BNP change was whether an individual underwent resting optimization or not (β = 0.38, P = 0.04). In those undergoing resting optimization, the degree of change in AV delay was correlated with improvement in left ventricle (LV) end-diastolic volume (r2 = 0.33, P < 0.01). Optimization on exercise was associated with a significant decrease in 6-minute walk test compared to those randomized to rest optimization possibly due to inducing nonoptimization at rest. In conclusion, echocardiographic optimization of CRT at rest is superior to no optimization or optimization on exercise. Patients with the greatest change in AV delay to reach optimal may undergo greater LV remodeling.
Keyword Heart failure
Cardiac resynchronization therapy
Brain natriuretic peptide
Ventricular remodeling
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Authors prepress title: "Haemodynamic Benefit of Rest and Exercise Optimization of Cardiac Resynchronization Therapy". Article first published online: 22 JAN 2014.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 4 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 4 times in Scopus Article | Citations
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Created: Tue, 25 Feb 2014, 13:56:55 EST by Tony Stanton on behalf of Medicine - Princess Alexandra Hospital