Pre-ejection period by radial artery tonometry supplements echo doppler findings during biventricular pacemaker optimization

Taha, Nima; Zhang, Jing; Rafie, Reza; Ranjan, Rupesh; Qamruddin, Salima; Naqvi, Tasneem Z.

doi:10.1186/1476-7120-9-20

Cited by 6 publications

(9 citation statements)

References 28 publications

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“…The vessel motion and blood flow with overlaid tissue elasticity, in response to a certain external pressure level, generate a unique pulsation in the RA, which is utilized for the diagnosis of various diseases by oriental clinicians [14]. Moreover, the RA is used to measure the central blood pressure by tonometry or a sphygmomanometer [15,16], and thus the RA was selected as the target vessel for HFUS in this study.…”

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confidence: 99%

Feasibility Study of High-Frequency Ultrasonic Blood Imaging in Human Radial Artery

et al. 2015

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The present study investigates cyclic variation in blood echogenicity (CVBE) in vivo using high-frequency ultrasound (HFUS). Blood echogenicity (BE) and vessel diameter (VD) were obtained from cross-sectional B-mode images of the radial artery of six volunteers (three young and three old volunteers) acquired at a frequency of 20 MHz. The magnitudes of the cyclic variations in BE and VD were 0.83 ± 0.18 dB and 0.29 ± 0.05 mm, respectively. CVBE was observed to be out of phase with the cyclic variation in VD, which is known to be in phase with blood flow velocity. This result is different from those in previous studies, which were performed in the carotid artery at lower frequencies. In addition, the magnitude of CVBE in the older group (0.96 ± 0.05 dB) was higher than that in the younger group (0.63 ± 0.06 dB, p \ 0.005), whereas the magnitude of variation in VD was not significantly different between the two groups (p = 0.119). This feasibility study suggests that HFUS B-mode blood imaging of human small vessels is useful for the noninvasive measurement or monitoring of the dynamic variation of hemorheological properties in human blood.

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confidence: 99%

Feasibility Study of High-Frequency Ultrasonic Blood Imaging in Human Radial Artery

et al. 2015

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“…Recent data available in the literature also indicate that there is a significant reduction in radial tonometry measured PEP postoptimization compared to preoptimization values and that this reduction correlates with echo Doppler measured improvements in hemodynamics. Optimization also significantly reduced the PEP/ED ratio . Moreover, data available in literature supporting the use of RAT in evaluating CRT response are still limited.…”

Section: Discussionmentioning

confidence: 99%

“…Data available in the literature indicate that radial artery tonometry (RAT) showed a good correspondence with the echo‐Doppler‐derived cardiac parameters (i.e., longer LV ejection duration [ED]) in CRT patients . In addition, it was recently demonstrated that an acute pre‐ejection period (PEP) shortening measured by radial tonometry occurs with optimization of AV and VV delay and correlates with improvement in hemodynamics measured by echocardiography (Figure ). Whether the PEP, ED, and PEP/ED ratio are modified by MPP interventions compared to conventional CRT and whether radial tonometry, in conjunction with an ECG, can detect these changes has not previously been investigated.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, radial tonometry was successfully acquired on every patient with only a few unsuccessful time points pointing out its reliability as noninvasive measurement. In the study by Taha et al, although PEP was measured with the SphygmoCor system, echo Doppler was used to measure ED 10. In the present study, a modified version of the same Sphygmo-Cor system also used by Taha et al has been adopted, which was able to acquire both parameters solely by radial tonometry.…”

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confidence: 97%

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Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry

Ciconte

Ćalović

Vicedomini

et al. 2018

Pacing Clinical Electrophis

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Background Multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP], Abbott, Sylmar, CA, USA) improves the response rate to cardiac resynchronization therapy (CRT). We evaluated the feasibility of noninvasive radial artery tonometry (RAT) to characterize arterial pressure morphology changes (pre‐ejection period [PEP] and ejection duration [ED]) between conventional CRT and MPP pacing interventions. Methods Patients with a MPP‐enabled CRT device (Quadra Assura MP™, Abbott) underwent noninvasive RAT assessment (SphygmoCor CVMS, AtCor Medical Inc., Itasca, IL, USA) at 3–6 months after implantation. A pacing protocol was performed in a randomized order including one optimized conventional biventricular CRT (CONV) configuration using the distal electrode and five MPP configurations. The PEP, ED, and PEP/ED ratio were determined for each intervention from the RAT pressure waveform and electrocardiogram. Results Pressure waveforms were successfully recorded in 19 patients (89% male, QRS 147 ± 16 ms, 63% ischemic). In 17/19 (89%) patients, at least one MPP intervention resulted in improved PEP, ED, and PEP/ED compared to CONV. The MPP intervention with greatest separation of LV cathodes and minimum intra‐LV delay significantly improved PEP (mean PEP –15 ± 33% vs –8 ± 32% [CONV], P = 0.04) and ED (mean ED +8 ± 8% [MPP] vs +4 ± 7% [CONV], P = 0.02), and PEP/ED (–0.07 ± 0.14 [MPP] vs –0.04 ± 0.13 [CONV], P = 0.02) compared with CONV. Conclusions Noninvasive RAT efficiently characterizes changes in PEP and ED between CONV and MPP interventions. MPP configurations using the widest separation among LV cathodes and minimum intra‐LV delay may significantly improve RAT‐derived parameters as compared to conventional CRT.

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“…Previous studies have shown that in patients with CRT, optimizing atrioventricular (AV) delay further improves stroke volume [3-6] and that optimal AV delay changes over time requiring periodic optimization [7]. There is controversy on optimal AV delay at increase in heart rate with exercise.…”

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confidence: 99%

Shortening of atrioventricular delay at increased atrial paced heart rates improves diastolic filling and functional class in patients with biventricular pacing

Rafie

Qamruddin

Ozhand

et al. 2012

Cardiovasc Ultrasound

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BackgroundUse of rate adaptive atrioventricular (AV) delay remains controversial in patients with biventricular (Biv) pacing. We hypothesized that a shortened AV delay would provide optimal diastolic filling by allowing separation of early and late diastolic filling at increased heart rate (HR) in these patients.Methods34 patients (75 ± 11 yrs, 24 M, LVEF 34 ± 12%) with Biv and atrial pacing had optimal AV delay determined at baseline HR by Doppler echocardiography. Atrial pacing rate was then increased in 10 bpm increments to a maximum of 90 bpm. At each atrial pacing HR, optimal AV delay was determined by changing AV delay until best E and A wave separation was seen on mitral inflow pulsed wave (PW) Doppler (defined as increased atrial duration from baseline or prior pacemaker setting with minimal atrial truncation). Left ventricular (LV) systolic ejection time and velocity time integral (VTI) at fixed and optimal AV delay was also tested in 13 patients. Rate adaptive AV delay was then programmed according to the optimal AV delay at the highest HR tested and patients were followed for 1 month to assess change in NYHA class and Quality of Life Score as assessed by Minnesota Living with Heart Failure Questionnaire.Results81 AV delays were evaluated at different atrial pacing rates. Optimal AV delay decreased as atrial paced HR increased (201 ms at 60 bpm, 187 ms at 70 bpm, 146 ms at 80 bpm and 123 ms at 90 bpm (ANOVA F-statistic = 15, p = 0.0010). Diastolic filling time (P < 0.001 vs. fixed AV delay), mitral inflow VTI (p < 0.05 vs fixed AV delay) and systolic ejection time (p < 0.02 vs. fixed AV delay) improved by 14%, 5% and 4% respectively at optimal versus fixed AV delay at the same HR. NYHA improved from 2.6 ± 0.7 at baseline to 1.7 ± 0.8 (p < 0.01) 1 month post optimization. Physical component of Quality of Life Score improved from 32 ± 17 at baseline to 25 ± 12 (p < 0.05) at follow up.ConclusionsIncreased heart rate by atrial pacing in patients with Biv pacing causes compromise in diastolic filling time which can be improved by AV delay shortening. Aggressive AV delay shortening was required at heart rates in physiologic range to achieve optimal diastolic filling and was associated with an increase in LV ejection time during optimization. Functional class improved at 1 month post optimization using aggressive AV delay shortening algorithm derived from echo-guidance at the time of Biv pacemaker optimization.

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Pre-ejection period by radial artery tonometry supplements echo doppler findings during biventricular pacemaker optimization

Cited by 6 publications

References 28 publications

Feasibility Study of High-Frequency Ultrasonic Blood Imaging in Human Radial Artery

Feasibility Study of High-Frequency Ultrasonic Blood Imaging in Human Radial Artery

Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry

Shortening of atrioventricular delay at increased atrial paced heart rates improves diastolic filling and functional class in patients with biventricular pacing

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