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Que peut-on encore demander agrave lrsquoeacutechographiste
CGoffinet
Que peut-on encore demander agrave lrsquoeacutechographiste
bullAsynchronisme ventriculairebullReacuteponse CRTbullOptimisation CRT
Mesurer lrsquoasynchronisme
2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Selection of HF patients for CRT based on LV mechanical dyssynchrony assessed with imaging techniques is uncertain and should therefore not be used as a selection criterion for CRT However data from several observational studies suggest that baseline LV mechanical dyssynchrony and acute resynchronization effect after CRT are independent determinants of CRT response and long-term outcome
En Belgiquehellip23 Pour une theacuterapie de resynchronisation le patient doit preacutesenter 1049458 Une classe NYHA III insuffisance cardiaque (malgreacute une theacuterapie meacutedicamenteuse optimale)1049458 Un complexe QRS compris en 120ms et 149ms avec un asynchronisme documenteacute ou un complexe QRS gt 150ms1049458 Un LBBB (left bundle branch block)
Clinical factors influencing the likelihood to respond to CRT
AuthorsTask Force Members et al Eur Heart J 2013342281-2329
CRT in heart failure with a narrow QRS (lt130ms) complex EchoCRT trial
NEJM 2013
CRT meacutecanisme
Yu C-M Chau E Sanderson J et al Yu C-M Chau E Sanderson J et al CirculationCirculation 2002105438-445 2002105438-445
IntraventricularIntraventricularSynchronySynchrony
AtrioventricularAtrioventricularSynchronySynchrony
InterventricularInterventricularSynchronySynchrony
LALAPressurePressure
LV DiastolicLV DiastolicFillingFilling
RV StrokeRV StrokeVolumeVolume
LVESVLVESV LVEDVLVEDV
Reverse RemodelingReverse Remodeling
Cardiac ResynchronizationCardiac Resynchronization
MRMR dPdt dPdt EF EF CO CO(( Pulse Pressure) Pulse Pressure)
Circulation Volume 117(20)2608-2616 May 20 2008
Results of the Predictors of Response to CRT (PROSPECT) Trial
by Eugene S Chung Angel R Leon Luigi Tavazzi Jing-Ping Sun Petros Nihoyannopoulos John Merlino William T Abraham Stefano Ghio Christophe Leclercq Jeroen J Bax Cheuk-Man Yu John Gorcsan Martin St John Sutton
Johan De Sutter and Jaime Murillo
bull M 71ansbull Cardiomyopathie non
ischeacutemique avec FE lt35bull BBGcomplet (144ms)bull Rmeacutedical optimal depuis 6
moisbull NYHA III
Cas clinique
Comment mesurer lrsquoasynchronisme
ndash Atrio-ventriculaire E+ARR lt40
489100ms = 49
interventriculaireAogt140msDeacutelaigt40ms
Comment mesurer lrsquoasynchronisme
100ms129ms
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Que peut-on encore demander agrave lrsquoeacutechographiste
bullAsynchronisme ventriculairebullReacuteponse CRTbullOptimisation CRT
Mesurer lrsquoasynchronisme
2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Selection of HF patients for CRT based on LV mechanical dyssynchrony assessed with imaging techniques is uncertain and should therefore not be used as a selection criterion for CRT However data from several observational studies suggest that baseline LV mechanical dyssynchrony and acute resynchronization effect after CRT are independent determinants of CRT response and long-term outcome
En Belgiquehellip23 Pour une theacuterapie de resynchronisation le patient doit preacutesenter 1049458 Une classe NYHA III insuffisance cardiaque (malgreacute une theacuterapie meacutedicamenteuse optimale)1049458 Un complexe QRS compris en 120ms et 149ms avec un asynchronisme documenteacute ou un complexe QRS gt 150ms1049458 Un LBBB (left bundle branch block)
Clinical factors influencing the likelihood to respond to CRT
AuthorsTask Force Members et al Eur Heart J 2013342281-2329
CRT in heart failure with a narrow QRS (lt130ms) complex EchoCRT trial
NEJM 2013
CRT meacutecanisme
Yu C-M Chau E Sanderson J et al Yu C-M Chau E Sanderson J et al CirculationCirculation 2002105438-445 2002105438-445
IntraventricularIntraventricularSynchronySynchrony
AtrioventricularAtrioventricularSynchronySynchrony
InterventricularInterventricularSynchronySynchrony
LALAPressurePressure
LV DiastolicLV DiastolicFillingFilling
RV StrokeRV StrokeVolumeVolume
LVESVLVESV LVEDVLVEDV
Reverse RemodelingReverse Remodeling
Cardiac ResynchronizationCardiac Resynchronization
MRMR dPdt dPdt EF EF CO CO(( Pulse Pressure) Pulse Pressure)
Circulation Volume 117(20)2608-2616 May 20 2008
Results of the Predictors of Response to CRT (PROSPECT) Trial
by Eugene S Chung Angel R Leon Luigi Tavazzi Jing-Ping Sun Petros Nihoyannopoulos John Merlino William T Abraham Stefano Ghio Christophe Leclercq Jeroen J Bax Cheuk-Man Yu John Gorcsan Martin St John Sutton
Johan De Sutter and Jaime Murillo
bull M 71ansbull Cardiomyopathie non
ischeacutemique avec FE lt35bull BBGcomplet (144ms)bull Rmeacutedical optimal depuis 6
moisbull NYHA III
Cas clinique
Comment mesurer lrsquoasynchronisme
ndash Atrio-ventriculaire E+ARR lt40
489100ms = 49
interventriculaireAogt140msDeacutelaigt40ms
Comment mesurer lrsquoasynchronisme
100ms129ms
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Mesurer lrsquoasynchronisme
2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Selection of HF patients for CRT based on LV mechanical dyssynchrony assessed with imaging techniques is uncertain and should therefore not be used as a selection criterion for CRT However data from several observational studies suggest that baseline LV mechanical dyssynchrony and acute resynchronization effect after CRT are independent determinants of CRT response and long-term outcome
En Belgiquehellip23 Pour une theacuterapie de resynchronisation le patient doit preacutesenter 1049458 Une classe NYHA III insuffisance cardiaque (malgreacute une theacuterapie meacutedicamenteuse optimale)1049458 Un complexe QRS compris en 120ms et 149ms avec un asynchronisme documenteacute ou un complexe QRS gt 150ms1049458 Un LBBB (left bundle branch block)
Clinical factors influencing the likelihood to respond to CRT
AuthorsTask Force Members et al Eur Heart J 2013342281-2329
CRT in heart failure with a narrow QRS (lt130ms) complex EchoCRT trial
NEJM 2013
CRT meacutecanisme
Yu C-M Chau E Sanderson J et al Yu C-M Chau E Sanderson J et al CirculationCirculation 2002105438-445 2002105438-445
IntraventricularIntraventricularSynchronySynchrony
AtrioventricularAtrioventricularSynchronySynchrony
InterventricularInterventricularSynchronySynchrony
LALAPressurePressure
LV DiastolicLV DiastolicFillingFilling
RV StrokeRV StrokeVolumeVolume
LVESVLVESV LVEDVLVEDV
Reverse RemodelingReverse Remodeling
Cardiac ResynchronizationCardiac Resynchronization
MRMR dPdt dPdt EF EF CO CO(( Pulse Pressure) Pulse Pressure)
Circulation Volume 117(20)2608-2616 May 20 2008
Results of the Predictors of Response to CRT (PROSPECT) Trial
by Eugene S Chung Angel R Leon Luigi Tavazzi Jing-Ping Sun Petros Nihoyannopoulos John Merlino William T Abraham Stefano Ghio Christophe Leclercq Jeroen J Bax Cheuk-Man Yu John Gorcsan Martin St John Sutton
Johan De Sutter and Jaime Murillo
bull M 71ansbull Cardiomyopathie non
ischeacutemique avec FE lt35bull BBGcomplet (144ms)bull Rmeacutedical optimal depuis 6
moisbull NYHA III
Cas clinique
Comment mesurer lrsquoasynchronisme
ndash Atrio-ventriculaire E+ARR lt40
489100ms = 49
interventriculaireAogt140msDeacutelaigt40ms
Comment mesurer lrsquoasynchronisme
100ms129ms
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Clinical factors influencing the likelihood to respond to CRT
AuthorsTask Force Members et al Eur Heart J 2013342281-2329
CRT in heart failure with a narrow QRS (lt130ms) complex EchoCRT trial
NEJM 2013
CRT meacutecanisme
Yu C-M Chau E Sanderson J et al Yu C-M Chau E Sanderson J et al CirculationCirculation 2002105438-445 2002105438-445
IntraventricularIntraventricularSynchronySynchrony
AtrioventricularAtrioventricularSynchronySynchrony
InterventricularInterventricularSynchronySynchrony
LALAPressurePressure
LV DiastolicLV DiastolicFillingFilling
RV StrokeRV StrokeVolumeVolume
LVESVLVESV LVEDVLVEDV
Reverse RemodelingReverse Remodeling
Cardiac ResynchronizationCardiac Resynchronization
MRMR dPdt dPdt EF EF CO CO(( Pulse Pressure) Pulse Pressure)
Circulation Volume 117(20)2608-2616 May 20 2008
Results of the Predictors of Response to CRT (PROSPECT) Trial
by Eugene S Chung Angel R Leon Luigi Tavazzi Jing-Ping Sun Petros Nihoyannopoulos John Merlino William T Abraham Stefano Ghio Christophe Leclercq Jeroen J Bax Cheuk-Man Yu John Gorcsan Martin St John Sutton
Johan De Sutter and Jaime Murillo
bull M 71ansbull Cardiomyopathie non
ischeacutemique avec FE lt35bull BBGcomplet (144ms)bull Rmeacutedical optimal depuis 6
moisbull NYHA III
Cas clinique
Comment mesurer lrsquoasynchronisme
ndash Atrio-ventriculaire E+ARR lt40
489100ms = 49
interventriculaireAogt140msDeacutelaigt40ms
Comment mesurer lrsquoasynchronisme
100ms129ms
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
CRT meacutecanisme
Yu C-M Chau E Sanderson J et al Yu C-M Chau E Sanderson J et al CirculationCirculation 2002105438-445 2002105438-445
IntraventricularIntraventricularSynchronySynchrony
AtrioventricularAtrioventricularSynchronySynchrony
InterventricularInterventricularSynchronySynchrony
LALAPressurePressure
LV DiastolicLV DiastolicFillingFilling
RV StrokeRV StrokeVolumeVolume
LVESVLVESV LVEDVLVEDV
Reverse RemodelingReverse Remodeling
Cardiac ResynchronizationCardiac Resynchronization
MRMR dPdt dPdt EF EF CO CO(( Pulse Pressure) Pulse Pressure)
Circulation Volume 117(20)2608-2616 May 20 2008
Results of the Predictors of Response to CRT (PROSPECT) Trial
by Eugene S Chung Angel R Leon Luigi Tavazzi Jing-Ping Sun Petros Nihoyannopoulos John Merlino William T Abraham Stefano Ghio Christophe Leclercq Jeroen J Bax Cheuk-Man Yu John Gorcsan Martin St John Sutton
Johan De Sutter and Jaime Murillo
bull M 71ansbull Cardiomyopathie non
ischeacutemique avec FE lt35bull BBGcomplet (144ms)bull Rmeacutedical optimal depuis 6
moisbull NYHA III
Cas clinique
Comment mesurer lrsquoasynchronisme
ndash Atrio-ventriculaire E+ARR lt40
489100ms = 49
interventriculaireAogt140msDeacutelaigt40ms
Comment mesurer lrsquoasynchronisme
100ms129ms
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Circulation Volume 117(20)2608-2616 May 20 2008
Results of the Predictors of Response to CRT (PROSPECT) Trial
by Eugene S Chung Angel R Leon Luigi Tavazzi Jing-Ping Sun Petros Nihoyannopoulos John Merlino William T Abraham Stefano Ghio Christophe Leclercq Jeroen J Bax Cheuk-Man Yu John Gorcsan Martin St John Sutton
Johan De Sutter and Jaime Murillo
bull M 71ansbull Cardiomyopathie non
ischeacutemique avec FE lt35bull BBGcomplet (144ms)bull Rmeacutedical optimal depuis 6
moisbull NYHA III
Cas clinique
Comment mesurer lrsquoasynchronisme
ndash Atrio-ventriculaire E+ARR lt40
489100ms = 49
interventriculaireAogt140msDeacutelaigt40ms
Comment mesurer lrsquoasynchronisme
100ms129ms
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
bull M 71ansbull Cardiomyopathie non
ischeacutemique avec FE lt35bull BBGcomplet (144ms)bull Rmeacutedical optimal depuis 6
moisbull NYHA III
Cas clinique
Comment mesurer lrsquoasynchronisme
ndash Atrio-ventriculaire E+ARR lt40
489100ms = 49
interventriculaireAogt140msDeacutelaigt40ms
Comment mesurer lrsquoasynchronisme
100ms129ms
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Comment mesurer lrsquoasynchronisme
ndash Atrio-ventriculaire E+ARR lt40
489100ms = 49
interventriculaireAogt140msDeacutelaigt40ms
Comment mesurer lrsquoasynchronisme
100ms129ms
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
interventriculaireAogt140msDeacutelaigt40ms
Comment mesurer lrsquoasynchronisme
100ms129ms
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
intraventriculaireSeptal to posterior wall motion delay M-mode gt130ms
Septal to lateral Ts delay Tissue velocity imaging gt60ms
Max delay in Ts in 4 basal LV segments Tissue velocity imaging gt65ms
SD of Ts of 6 basal LV segments Tissue velocity imaging gt365ms
Max delay in Ts in 12 basal and mid LV segments
Tissue velocity imaging gt100ms
SD of Ts in 12 basal and mid LV segments (Dyssynchrony Index)
Tissue velocity imaging gt326ms
Anteroseptal to posterior time to peak strain difference (radial strain)
Speckle tracking gt130ms
SD of time-to peak longitudinal strain in 12 basal and mid LV segments
Coloour-TDI
SD of time-to peak longitudinal strain in 12 basal and mid LV segments (systolic dyssynchrony index)
3D echo gt56
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Comment mesurer lrsquoasynchronisme
M-Mode
Delai gt130ms
110ms
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
TDI
bull Deacutependance de lrsquoanglebull Trop de variabiliteacute inter et intra-obs
60ms
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Speckle tracking 2D strain
Longitudinal transverse strain
radialcircomfeacuterentiel
Eacutetude STAR
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy results of the Speckle Tracking and Resynchronization (STAR) studyHTanaka European Heart Journal (2010) 31 1690
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Speckle tracking 2D strain
Deacutelai 171ms
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Speckle tracking 2D strain
Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with CRT MADIT-CRT trail
EHJ 2011 Pouleur AC
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
2D strain et dobutamine
bull Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Apical rocking
Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy Stankovic I Eur Heart J 2013 Aug 4
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
3D
bull Index drsquoasynchronismendash Qualiteacute imagendash Frame rate
Delgado V Bax J Circulation 2011123640-655
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Il nrsquoy a pas que lrsquoasynchronisme
ndash NYHAndash Dureacutee QRSndash Viabiliteacutendash Lead positionndash Reacuteglage de la CRT
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Reponse agrave la CRT
ndash Mortaliteacutendash Hospitalisationndash QOLndash 6min walking testndash ECHO
bull Fraction drsquoeacutejectionbull volumes ventriculairesbull IM
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Optimisation de CRT
Delai AV
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Optimisation de CRT
Ritter formula
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Myocardial performance index = ((A-E time) - LV ejection time) LV ejection time
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Optimisation de CRT
Bertini M et al Europace 200911v46-v57
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Optimisation de CRT
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Optimisation de CRT
Deacutelai AV 120msVV fixe
Follow upAmeacutelioration
Pas de modification
Deacutelai AV et ECHO
Deacutelai le plus court meilleur remplissage VG (A)
ECHO ndash smart device
Optimisation ECHO (stroke volume et asynchronisme)
Smart deviceDureacutee du QRS
Deacutelai VV
oui
non
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Changes in LVESV the fixed AVI of 120 ms
Ellenbogen et al Circulation 2010
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Mullens W et al J Am Coll Cardiol 2009
Should the AV interval be optimized
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Bogaard et al Europace 2012
Effects of AV and VVdelay programming on LV pressure rise
In 23-33 (A Vsense)
In 32-357 (A Vpace)
In 45 (VV delay)
Useful
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
O Soliman et al
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Bogaard et al Europace 2012
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays
Bogaard et al Europace 2012
Correlation of characteristicsto individual optimal AV and VV delays