Immediate and chronic effects of AV-delay optimization in patients with cardiac resynchronization therapy

Background: Acute changes of the AV-delay in CRT patients have a significant impact on hemodynamics. However, the chronic functional effects of AV-delay optimization have not been systematically examined despite of their potential role for chronic functional improvement. Methods: Therefore, in this study we investigated whether optimization of AV-delay in CRT patients as assessed by echocardiographic measurement of the velocity time integral of the left ventricular outflow tract (LVOT-VTI) chronically changes (1) echocardiographic parameters of systolic and diastolic left ventricular function, (2) walking distance in the 6-min walk test, (3) levels of NT-proBNP and (4) quality of life as assessed by a standard questionnaire, 3 3 patients underwent optimization of AV-delay 3 1 8 weeks after initiation of CRT. Follow up (FU) was conducted 43 5 days later. Results: E/Ea, the ratio of peak E-wave of mitral inflow and of TDI of the mitral annulus, significantly decreased immediately post-optimization (11 +/- 1 vs. 14 +/- 1 at baseline, p < 0.05) and further decreased at FU (8 +/- 1, p < 0.05 vs. immediately post-optimization) indicating improvement of diastolic function, while traditional parameters of diastolic function derived from pulse wave Doppler remained unchanged. There was a slight increase of LV-ejection fraction as assessed by echocardiography acutely after optimization (baseline: 25 +/- 2%, optimized: 28 +/- 1%, p < 0.05), while LV-ejection fraction at FU did not differ from baseline. 6-min walk test improved from 449 +/- 17 m (baseline) to 475 +/- 17 m at FU (p < 0.05). During this period NT-proBNP significantly decreased from 3193 +/- 765 ng/l to 2593 +/- 675 ng/l (p < 0.05). Quality of life was unchanged at FU. Conclusion: This study demonstrates for the first time chronic functional improvement due to AV-delay optimization in patients with CRT. (c) 2006 Elsevier Ireland Ltd. All rights reserved.