Article Text
Abstract
Background Patient-specific left ventricular (LV) lead optimisation strategies with immediate feedback on cardiac resynchronisation therapy (CRT) effectiveness are needed. The purpose of this study was to compare contractility surrogates derived from biventricular lead motion analysis to the peak positive time derivative of LV pressure (dP/dtmax) in patients undergoing CRT implantation.
Methods Twenty-seven patients underwent CRT implantation with continuous haemodynamic monitoring. The right ventricular (RV) lead was placed in apex and a quadripolar LV lead was placed laterally. Biplane fluoroscopy cine films facilitated construction of three-dimensional RV–LV interlead distance waveforms at baseline and under biventricular pacing (BIVP) from which the following contractility surrogates were derived; fractional shortening (FS), time to peak systolic contraction and peak shortening of the interlead distance (negative slope). Acute haemodynamic CRT response was defined as LV ∆dP/dtmax ≥ 10 %.
Results We observed a mean increase in dP/dtmax under BIVP (899±205 mm Hg/s vs 777±180 mm Hg/s, p<0.001). Based on ΔdP/dtmax, 18 patients were classified as acute CRT responders and nine as non-responders (23.3%±10.6% vs 1.9±5.3%, p<0.001). The baseline RV–LV interlead distance was associated with echocardiographic LV dimensions (end diastole: R=0.61, p=0.001 and end systole: R=0.54, p=0.004). However, none of the contractility surrogates could discriminate between the acute CRT responders and non-responders (ΔFS: −2.5±2.6% vs − 2.0±3.1%, p=0.50; Δtime to peak systolic contraction: −9.7±18.1% vs −10.8±15.1%, p=0.43 and Δpeak negative slope: −8.7±45.9% vs 12.5±54.8 %, p=0.09).
Conclusion The baseline RV–LV interlead distance was associated with echocardiographic LV dimensions. In CRT recipients, contractility surrogates derived from the RV–LV interlead distance waveform could not discriminate between acute haemodynamic responders and non-responders.
- cardiac resynchronisation therapy
- haemodynamics
- fluoroscopy
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Footnotes
Contributors HHO, TF, TE, LOG, RC and EK contributed substantially to conception and design. SR, HHO, TF, LOG, TFH, and EK contributed substantially to data collection. SR, HHO, TF, TE, LOG, TFH, RC and EK contributed substantially to analysis and interpretation of data, drafting and revising the manuscript for important intellectual content. SR, HHO, TF, TE, LOG, TFH, RC and EK provided final approval of the submitted manuscript. There is no one else that fulfills the ICMJE recommendations for authorship that has been excluded as an author.
Funding Center for Cardiological innovation (CCI) is funded by the Research council of Norway (project number 203489/o30). PhD candidate Stian Ross has received additional funding from South-Eastern Norway Regional Health Authority (project number 2015054). The study sponsors had no role in the study design; collection, analysis and interpretation of the data; in writing the manuscript or in the decision to submit the paper for publication. Trent Fischer, Lars Ove Gammelsrud and Richard Cornelussen are full time Medtronic employees.
Competing interests Trent Fischer, Lars Ove Gammelsrud and Richard Cornelussen are full time Medtronic employees.
Patient consent for publication Not required.
Ethics approval Regional ethical committe of the South-Eastern Norway Regional Health Authority.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.