Biventricular pacemaker optimization guided by comprehensive echocardiography - Preliminary observations regarding the effects on systolic and diastolic ventricular function and third heart sound

Nima Taha, Jing Zhang, Rupesh Ranjan, Samuel Daneshvar, Edilzar Castillo, Elizabeth Guillen, Martha C. Montoya, Giovanna Velasquez, Tasneem Z. Naqvi

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Doppler echocardiography of mitral inflow or aortic outflow or both has been validated and advocated to guide biventricular (Biv) pacemaker optimization. A comprehensive and tailored Doppler echocardiographic evaluation may be required in patients with heart failure to assist with Biv pacemaker optimization. The third heart sound (S3), an acoustic cardiographic parameter, has been demonstrated to be a highly specific finding for hemodynamic evaluation in patients with heart failure. The aims of this study were to evaluate the use of comprehensive Doppler echocardiography as a guide during Biv pacemaker optimization in patients after cardiac resynchronization therapy and to evaluate the feasibility of S3 intensity to be a cost-efficient parameter for Biv pacemaker optimization compared with Doppler echocardiography. Methods: Comprehensive Doppler echocardiographic evaluations were performed during Biv pacemaker optimization in 44 patients referred for pacemaker optimization (mean age, 71 ± 12 years; mean left ventricular ejection fraction, 34 ± 11%). Blinded assessment of S3 intensity was performed simultaneously using acoustic cardiography. The correlation and improvement in cardiac hemodynamics were analyzed between the methods. Results: Echocardiographically guided optimization resulted in significant improvements in the left ventricular outflow velocity-time integral (15.92 ± 4.77 to 18.51 ± 5.19 cm, P < .001), ejection time (278 ± 40 to 293 ± 40 ms, P < .001), myocardial performance index (0.57 ± 0.19 to 0.44 ± 0.14, P < .002), and peak pulmonary artery systolic pressure (42 ± 13 to 36 ± 11 mm Hg, P < .04) and decreased S 3 intensity from 4.81 ± 1.84 at baseline to 3.96 ± 1.22 after optimization (P < .02) for the overall study group and from 6.63 ± 1.37 to 4.85 ± 1.13 (P < .001) in the 18 patients with baseline S3 intensity > 5.0. The correlation between echocardiographic and acoustic cardiographic S3 intensity for optimal atrioventricular delay was 0.86 (P < .001) and for optimal interventricular delay was 0.64 (P < .001). Optimal atrioventricular delay was identical by echocardiographic and acoustic cardiographic S3 intensity in 56%, and optimal interventricular delay was identical in 75% of patients. Pacemakers were permanently programmed on the basis of echocardiographic evaluation. In 35 patients available for follow up, the mean New York Heart Association class reduced from 2.55 ± 0.81 to 1.77 ± 0.90 (P < .001) and the mean quality-of-life score as assessed by Minnesota Living With Heart Failure Questionnaire improved from 45 ± 28 to 32 ± 28 (P = .08) at 2.5 ± 2.1 months. Conclusion: Comprehensive echocardiographically guided Biv pacemaker optimization produces significant improvement in Doppler echocardiographic hemodynamics, a reduction in S3 intensity, and an improvement in functional class in patients after cardiac resynchronization therapy.

Original languageEnglish (US)
Pages (from-to)857-866
Number of pages10
JournalJournal of the American Society of Echocardiography
Volume23
Issue number8
DOIs
StatePublished - May 26 2010

Keywords

  • Acoustic cardiography
  • Biventricular pacemaker
  • Doppler
  • Echocardiography
  • Pacemaker optimization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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