Acute Beneficial Hemodynamic Effects of a Novel 3D-Echocardiographic Optimization Protocol in Cardiac Resynchronization Therapy

Post-implantation therapies to optimize cardiac resynchronization therapy (CRT) focus on adjustments of the atrio-ventricular (AV) delay and ventricular-to-ventricular (VV) interval. However, there is little consensus on how to achieve best resynchronization with these parameters. The aim of this study was to examine a novel combination of doppler echocardiography (DE) and three-dimensional echocardiography (3DE) for individualized optimization of device based AV delays and VV intervals compared to empiric programming.25 recipients of CRT (male: 56%, mean age: 67 years) were included in this study. Ejection fraction (EF), the primary outcome parameter, and left ventricular (LV) dimensions were evaluated by 3DE before CRT (baseline), after AV delay optimization while pacing the ventricles simultaneously (empiric VV interval programming) and after individualized VV interval optimization. For AV delay optimization aortic velocity time integral (AoVTI) was examined in eight different AV delays, and the AV delay with the highest AoVTI was programmed. For individualized VV interval optimization 3DE full-volume datasets of the left ventricle were obtained and analyzed to derive a systolic dyssynchrony index (SDI), calculated from the dispersion of time to minimal regional volume for all 16 LV segments. Consecutively, SDI was evaluated in six different VV intervals (including LV or right ventricular preactivation), and the VV interval with the lowest SDI was programmed (individualized optimization).EF increased from baseline 23±7% to 30±8 (p<0.001) after AV delay optimization and to 32±8% (p<0.05) after individualized optimization with an associated decrease of end-systolic volume from a baseline of 138±60 ml to 115±42 ml (p<0.001). Moreover, individualized optimization significantly reduced SDI from a baseline of 14.3±5.5% to 6.1±2.6% (p<0.001).Compared with empiric programming of biventricular pacemakers, individualized echocardiographic optimization with the integration of 3-dimensional indices into the optimization protocol acutely improved LV systolic function and decreased ESV and can be used to select the optimal AV delay and VV interval in CRT

Prädiktion der Operabilität und des Outcomes von Patienten mit nicht-kleinzelligem Lungenkarzinom mittels der integrierten [18F] FDG-PET/CT

Fast and accurate staging is essential for choosing treatment for NSCLC. The purpose of this prospective, non-randomized trial was to evaluate the reliability of PET/CT for staging of NSCLC compared to CT and PET alone and the ability of PET/CT in clinical decision making for further individual treatment dependent on UICC. 267 patients with suspected NSCLC were examined using PET/CT. A biopsy was performed on all patients. 185 patients showed NSCLC: 80 patients underwent surgery (pathologic staging), 105 patients maintained chemotherapy and/or radiotherapy. Imaging modalities were evaluated independently. The patients were divided into 2 groups: curative surgery (UICC IIIA). Follow-up data for all patients were obtained. Endpoint was death of any cause. In 80 operated NSCLC-patients the accuracy of CT, PET and PET/CT in T-staging was 66.3 %, 70.0 % and 80.0 %, respectively. PET/CT was significantly superior (p 0.05). The median follow-up was 453 (6 - 1710) days. At close-out 55 patients were alive, 103 patients had died, 25 patients were censored at the last contact date. For 2 patients no follow-up data could be received (drop-outs). All diagnostic methods significantly distinguished between operable vs. inoperable NSCLS (p IIIA (inoperable) vs. PET stating UICC <= IIIA (operable) (p < 0.05). PET/CT was significantly more accurate for staging of NSCLC and a better differentiation between operable vs. inoperable NSCLC stadium was obtained

Acute hemodynamic effects of 3D-echocardiography guided optimization.

<p>Hemodynamic variables for each timestep of the optimization protocol: A) systolic dyssynchrony index, B) ejection fraction, and C) left-ventricular end-diastolic and end-systolic volumes. Shown are means ± standard deviation. * p<0.05 vs. baseline values.</p

Echocardiographic parameters at baseline and after AV delay and VV interval optimization.

<p>SDI, systolic dyssynchrony index; AV, atrio-ventricular; VV, ventriculo-ventricular; LV, left ventricular; VTI, velocity-time integral.</p><p>Shown are means ± standard deviation.</p>†<p>p<0.001: for comparison of AV optimization vs baseline.</p>¶<p>p<0.05: for comparison of complete optimization vs AV optimization only.</p><p>*p<0.05: for comparison of complete optimization vs baseline.</p

Baseline characteristics.

<p>Values are shown as means ± standard deviation or count (percentage).</p><p>NYHA, New York Heart Association; CMP, cardiomyopathy; ACE, Angiotensin-converting enzyme; ARB, Angiotensin receptor blocker; LV, left ventricle; SDI, systolic dyssynchrony index.</p

Ventricular-to-ventricular (VV) intervals in patients with ischemic and dilated cardiomyopathy.

<p>Number of patients with simultaneous activation of left and right ventricle or sequential inter-ventricular pacing depending on ischemic or dilated cardiomyopathy.</p