Noninvasive Imaging in Cardiac Resynchronization Therapy—Part 2: Follow‐up and Optimization of Settings

Cardiac resynchronization therapy (CRT) has become a therapeutic option for drug‐refractory heart failure. Several noninvasive imaging techniques play an increasingly important role before and after device implantation. This review highlights the acute and long‐term CRT benefits after implantation as assessed with echocardiography and nuclear imaging. Furthermore, optimization of CRT settings, in particular atrioventricular and interventricular delay, will be discussed using echocardiography and other (device‐based) techniques.

[1]  J. Daubert,et al.  Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure. , 2005, Journal of the American College of Cardiology.

[2]  J. Kautzner,et al.  Influence of Different Atrioventricular and Interventricular Delays on Cardiac Output During Cardiac Resynchronization Therapy , 2005, Pacing and clinical electrophysiology : PACE.

[3]  L. Padeletti,et al.  Effects of cardiac resynchronization therapy on the mechanisms underlying functional mitral regurgitation in congestive heart failure. , 2006, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[4]  Jeroen J. Bax,et al.  Left ventricular dyssynchrony predicts right ventricular remodeling after cardiac resynchronization therapy. , 2005, Journal of the American College of Cardiology.

[5]  Markus Roos,et al.  Comparison of different approaches for optimization of atrioventricular and interventricular delay in biventricular pacing. , 2008, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[6]  M. Kurabayashi,et al.  Usefulness of biventricular pacing to improve cardiac symptoms, exercise capacity and sympathetic nerve activity in patients with moderate to severe chronic heart failure. , 2006, Circulation journal : official journal of the Japanese Circulation Society.

[7]  A. Rossi,et al.  Atrioventricular Delay Optimization by Doppler‐Derived Left Ventricular dP/dt Improves 6‐Month Outcome of Resynchronized Patients , 2006, Pacing and clinical electrophysiology : PACE.

[8]  Jeroen J. Bax,et al.  Acute effects of initiation and withdrawal of cardiac resynchronization therapy on papillary muscle dyssynchrony and mitral regurgitation. , 2007, Journal of the American College of Cardiology.

[9]  P. Mabo,et al.  Haemodynamic benefit of a rate-adapted A-V delay in dual chamber pacing. , 1989, European heart journal.

[10]  Angelo Auricchio,et al.  Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy. , 2002, Journal of the American College of Cardiology.

[11]  A. Hamer,et al.  Long‐Term Variations in Optimal Programming of Cardiac Resynchronization Therapy Devices , 2005, Pacing and clinical electrophysiology : PACE.

[12]  T. Nielsen,et al.  Regional myocardial perfusion during chronic biventricular pacing and after acute change of the pacing mode in patients with congestive heart failure and bundle branch block treated with an atrioventricular sequential biventricular pacemaker , 2003, European journal of heart failure.

[13]  K. Airaksinen,et al.  Assessment of right ventricular oxidative metabolism by PET in patients with idiopathic dilated cardiomyopathy undergoing cardiac resynchronization therapy. , 2004, European journal of nuclear medicine and molecular imaging.

[14]  Christian Butter,et al.  Cardiac resynchronization therapy optimization by finger plethysmography. , 2004, Heart rhythm.

[15]  E. Foster,et al.  Reduced Ventricular Volumes and Improved Systolic Function With Cardiac Resynchronization Therapy: A Randomized Trial Comparing Simultaneous Biventricular Pacing, Sequential Biventricular Pacing, and Left Ventricular Pacing , 2007, Circulation.

[16]  Jeroen J. Bax,et al.  Usefulness of myocardial tissue Doppler echocardiography to evaluate left ventricular dyssynchrony before and after biventricular pacing in patients with idiopathic dilated cardiomyopathy. , 2003, The American journal of cardiology.

[17]  B. Nowak,et al.  Cardiac resynchronization therapyhomogenizes myocardial glucosemetabolism and perfusion in dilatedcardiomyopathy and left bundle branch block , 2003 .

[18]  Albert Meijer,et al.  Correlation of echo-Doppler optimization of atrioventricular delay in cardiac resynchronization therapy with invasive hemodynamics in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. , 2006, The American journal of cardiology.

[19]  R. Chirife.  Prospective comparison of echocardiographic atrioventricular delay optimization methods for cardiac resynchronization therapy. , 2006, Heart rhythm.

[20]  K. Werdan,et al.  Impedance cardiography: a useful and reliable tool in optimization of cardiac resynchronization devices. , 2007, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[21]  Jeroen J. Bax,et al.  Cardiac Resynchronization Induces Favorable Neurohumoral Changes , 2005, Pacing and clinical electrophysiology : PACE.

[22]  The Optimized V‐V Interval Determined by Interventricular Conduction Times Versus Invasive Measurement by LVdP/dtMAX , 2008, Journal of cardiovascular electrophysiology.

[23]  Bristow.  Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) : Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure , 2004 .

[24]  W. Braham,et al.  Cardiac Resynchronization in Chronic Heart Failure , 2002 .

[25]  Improvements in left ventricular diastolic function after cardiac resynchronization therapy are coupled to response in systolic performance. , 2005, Journal of the American College of Cardiology.

[26]  W. Abraham,et al.  Optimization of cardiac resynchronization devices using acoustic cardiography: a comparison to echocardiography. , 2006, Congestive heart failure.

[27]  Jeroen J. Bax,et al.  The effects of cardiac resynchronization therapy on left ventricular function, myocardial energetics, and metabolic reserve in patients with dilated cardiomyopathy and heart failure. , 2004, Journal of the American College of Cardiology.

[28]  Leonie Johnston,et al.  Left ventricular resynchronization predicted by individual performance of right and left univentricular pacing: a study on the impact of sequential biventricular pacing on ventricular dyssynchrony. , 2007, Heart rhythm.

[29]  D. DeMets,et al.  Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. , 2004, The New England journal of medicine.

[30]  D. Shah,et al.  Optimization of Device Programming for Cardiac Resynchronization Therapy , 2006, Pacing and clinical electrophysiology : PACE.

[31]  C. Lau,et al.  Impedance Cardiography for Atrioventricular Interval Optimization During Permanent Left Ventricular Pacing , 2003, Pacing and clinical electrophysiology : PACE.

[32]  A. Waggoner,et al.  Randomized prospective trial of atrioventricular delay programming for cardiac resynchronization therapy. , 2004, Heart rhythm.

[33]  L. de las Fuentes,et al.  Cardiac resynchronization therapy acutely improves diastolic function. , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[34]  Jiang Ding,et al.  A Prospective Comparison of AV Delay Programming Methods for Hemodynamic Optimization during Cardiac Resynchronization Therapy , 2007, Journal of cardiovascular electrophysiology.

[35]  Jeroen J. Bax,et al.  Left Ventricular Reverse Remodeling but Not Clinical Improvement Predicts Long-Term Survival After Cardiac Resynchronization Therapy , 2005, Circulation.

[36]  K. Airaksinen,et al.  Assessment of right ventricular oxidative metabolism by PET in patients with idiopathic dilated cardiomyopathy undergoing cardiac resynchronisation therapy , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[37]  Milton Packer,et al.  Cardiac resynchronization in chronic heart failure. , 2002, The New England journal of medicine.

[38]  P. Zanco,et al.  Effect of biventricular pacing on metabolism and perfusion in patients affected by dilated cardiomyopathy and left bundle branch block: evaluation by positron emission tomography. , 2003, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[39]  Christophe Leclercq,et al.  Cardiac resynchronization therapy: Part 2--issues during and after device implantation and unresolved questions. , 2005, Journal of the American College of Cardiology.

[40]  L. Rydén,et al.  Effects of biventricular pacing on myocardial blood flow and oxygen consumption using carbon-11 acetate positron emission tomography in patients with heart failure. , 2003, The American journal of cardiology.

[41]  Jiang Ding,et al.  Cardiac resynchronization therapy restores optimal atrioventricular mechanical timing in heart failure patients with ventricular conduction delay. , 2002, Journal of the American College of Cardiology.

[42]  W. Burchert,et al.  Cardiac efficiency and oxygen consumption measured with 11C-acetate PET after long-term cardiac resynchronization therapy. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[43]  J. Daubert,et al.  Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. , 2001, The New England journal of medicine.

[44]  J. Mayet,et al.  Selection and optimisation of biventricular pacing: the role of echocardiography , 2004, Heart.

[45]  Jamil Mayet,et al.  Determination of optimal atrioventricular delay for cardiac resynchronization therapy using acute non-invasive blood pressure. , 2006, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[46]  Giuseppe Boriani,et al.  Randomized comparison of simultaneous biventricular stimulation versus optimized interventricular delay in cardiac resynchronization therapy. The Resynchronization for the HemodYnamic Treatment for Heart Failure Management II implantable cardioverter defibrillator (RHYTHM II ICD) study. , 2006, American heart journal.

[47]  B. Kristensen,et al.  Sequential Versus Simultaneous Biventricular Resynchronization for Severe Heart Failure: Evaluation by Tissue Doppler Imaging , 2002, Circulation.

[48]  R. Canby,et al.  Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. , 2003, JAMA.

[49]  Li Wang,et al.  Fundamentals of intrathoracic impedance monitoring in heart failure. , 2007, The American journal of cardiology.

[50]  Jeroen J. Bax,et al.  Noninvasive Imaging in Cardiac Resynchronization Therapy—Part 1: Selection of Patients , 2008, Pacing and clinical electrophysiology : PACE.

[51]  Giuseppe Ricciardi,et al.  Echocardiographic examination of atrioventricular and interventricular delay optimization in cardiac resynchronization therapy. , 2005, The American journal of cardiology.

[52]  Albert Meijer,et al.  Effect of optimizing the VV interval on left ventricular contractility in cardiac resynchronization therapy. , 2004, The American journal of cardiology.

[53]  Jeroen J. Bax,et al.  Effect of Posterolateral Scar Tissue on Clinical and Echocardiographic Improvement After Cardiac Resynchronization Therapy , 2006, Circulation.

[54]  L. Padeletti,et al.  Temporal variation in optimal atrioventricular and interventricular delay during cardiac resynchronization therapy. , 2006, Journal of cardiac failure.

[55]  Andreas Franke,et al.  Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. , 2003, Journal of the American College of Cardiology.

[56]  James D. Thomas,et al.  Tissue synchronization imaging and optimal left ventricular pacing site in cardiac resynchronization therapy. , 2006, The American journal of cardiology.

[57]  John Gorcsan,et al.  Echocardiography and Resynchronization A Mechanism for Immediate Reduction in Mitral Regurgitation After Cardiac Resynchronization Therapy Insights From Mechanical Activation Strain Mapping , 2004 .

[58]  E. Fallen,et al.  Effect of Cardiac Resynchronization on Myocardial Efficiency and Regional Oxidative Metabolism , 2003, Circulation.

[59]  E. Foster,et al.  Effects of Long-Term Biventricular Stimulation for Resynchronization on Echocardiographic Measures of Remodeling , 2002, Circulation.

[60]  F. Morady,et al.  Rate‐Dependent AV Delay Optimization in Cardiac Resynchronization Therapy , 2005, Pacing and clinical electrophysiology : PACE.

[61]  Andrew P. Kramer,et al.  Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. The Pacing Therapies for Congestive Heart Failure Study Group. The Guidant Congestive Heart Failure Research Group. , 1999, Circulation.

[62]  Cheuk-Man Yu,et al.  The role of repeating optimization of atrioventricular interval during interim and long-term follow-up after cardiac resynchronization therapy. , 2008, International journal of cardiology.

[63]  Jeroen J. Bax,et al.  Left Ventricular Resynchronization Is Mandatory for Response to Cardiac Resynchronization Therapy: Analysis in Patients With Echocardiographic Evidence of Left Ventricular Dyssynchrony at Baseline , 2007, Circulation.

[64]  Chu-Pak Lau,et al.  Tissue Doppler Echocardiographic Evidence of Reverse Remodeling and Improved Synchronicity by Simultaneously Delaying Regional Contraction After Biventricular Pacing Therapy in Heart Failure , 2002, Circulation.

[65]  H. Schieffer,et al.  Optimizing the AV Delay in DDD Pacemaker Patients with High Degree AV Block: Mitral Valve Doppler Versus Impedance Cardiography , 1997, Pacing and clinical electrophysiology : PACE.

[66]  Jacques Victor,et al.  Programming Optimal Atrioventricular Delay in Dual Chamber Pacing Using Peak Endocardial Acceleration: Comparison with a Standard Echocardiographic Procedure , 2003, Pacing and clinical electrophysiology : PACE.

[67]  T. D. de Backer,et al.  Tailored echocardiographic interventricular delay programming further optimizes left ventricular performance after cardiac resynchronization therapy. , 2005, Heart rhythm.

[68]  E. Milan,et al.  Effects of left bundle branch block on myocardial FDG PET in patients without significant coronary artery stenoses. , 2000, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[69]  R. Körfer,et al.  Effect of cardiac resynchronization therapy on global and regional oxygen consumption and myocardial blood flow in patients with non-ischaemic and ischaemic cardiomyopathy. , 2005, European heart journal.

[70]  David L Hayes,et al.  Sustained Reverse Left Ventricular Structural Remodeling With Cardiac Resynchronization at One Year Is a Function of Etiology: Quantitative Doppler Echocardiographic Evidence From the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) , 2006, Circulation.

[71]  Effects of cardiac resynchronization therapy on myocardial blood flow measured by oxygen-15 water positron emission tomography in idiopathic-dilated cardiomyopathy and left bundle branch block. , 2004, The American journal of cardiology.

[72]  D. Delurgio,et al.  Effect of Cardiac Resynchronization Therapy on Left Ventricular Size and Function in Chronic Heart Failure , 2003, Circulation.

[73]  M. Haissaguerre,et al.  Echocardiographic assessment during exercise of heart failure patients with cardiac resynchronization therapy. , 2006, The American journal of cardiology.

[74]  B. Nowak,et al.  Cardiac resynchronization therapy homogenizes myocardial glucose metabolism and perfusion in dilated cardiomyopathy and left bundle branch block. , 2003, Journal of the American College of Cardiology.

[75]  Prashanthan Sanders,et al.  Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing. , 2004, Journal of the American College of Cardiology.