Applicability of the iterative technique for cardiac resynchronization therapy optimization: full-disclosure, 50-sequential-patient dataset of transmitral Doppler traces, with implications for future research design and guidelines

Siana Jones*, Matthew J. Shun-Shin, Graham D. Cole, Arunashis Sau, Katherine March, Suzanne Williams, Andreas Kyriacou, Alun D. Hughes, Jamil Mayet, Michael Frenneaux, Charlotte H. Manisty, Zachary I. Whinnett, Darrel P. Francis

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Full-disclosure study describing Doppler patterns during iterative atrioventricular delay (AVD) optimization of biventricular pacemakers (cardiac resynchronization therapy, CRT).

Doppler traces of the first 50 eligible patients undergoing iterative Doppler AVD optimization in the BRAVO trial were examined. Three experienced observers classified conformity to guideline-described patterns. Each observer then selected the optimum AVD on two separate occasions: blinded and unblinded to AVD. Four Doppler E-A patterns occurred: A (always merged, 18 of patients), B (incrementally less fusion at short AVDs, 12), C (full separation at short AVDs, as described by the guidelines, 28), and D (always separated, 42). In Groups A and D (60), the iterative guidelines therefore cannot specify one single AVD. On the kappa scale (0 chance alone; 1 perfect agreement), observer agreement for the ideal AVD in Classes B and C was poor (0.32) and appeared worse in Groups A and D (0.22). Blinding caused the scattering of the AVD selected as optimal to widen (standard deviation rising from 37 to 49 ms, P 0.001). By blinding 28 of the selected optimum AVDs were 60 or 200 ms. All 50 Doppler datasets are presented, to support future methodological testing.

In most patients, the iterative method does not clearly specify one AVD. In all the patients, agreement on the ideal AVD between skilled observers viewing identical images is poor. The iterative protocol may successfully exclude some extremely unsuitable AVDs, but so might simply accepting factory default. Irreproducibility of the gold standard also prevents alternative physiological optimization methods from being validated honestly.

Original languageEnglish
Pages (from-to)541-550
Number of pages10
JournalEuropace
Volume16
Issue number4
DOIs
Publication statusPublished - Apr 2014

Keywords

  • atrioventricular delay (AVD)
  • doppler echocardiography
  • optimization
  • biventricular pacemaker optimization
  • chronic heart-failure
  • atrioventricular delay
  • follow-up
  • echocardiography
  • recommendations
  • intervals

Cite this

Applicability of the iterative technique for cardiac resynchronization therapy optimization : full-disclosure, 50-sequential-patient dataset of transmitral Doppler traces, with implications for future research design and guidelines. / Jones, Siana; Shun-Shin, Matthew J.; Cole, Graham D.; Sau, Arunashis; March, Katherine; Williams, Suzanne; Kyriacou, Andreas; Hughes, Alun D.; Mayet, Jamil; Frenneaux, Michael; Manisty, Charlotte H.; Whinnett, Zachary I.; Francis, Darrel P.

In: Europace, Vol. 16, No. 4, 04.2014, p. 541-550.

Research output: Contribution to journalArticle

Jones, S, Shun-Shin, MJ, Cole, GD, Sau, A, March, K, Williams, S, Kyriacou, A, Hughes, AD, Mayet, J, Frenneaux, M, Manisty, CH, Whinnett, ZI & Francis, DP 2014, 'Applicability of the iterative technique for cardiac resynchronization therapy optimization: full-disclosure, 50-sequential-patient dataset of transmitral Doppler traces, with implications for future research design and guidelines', Europace, vol. 16, no. 4, pp. 541-550. https://doi.org/10.1093/europace/eut257
Jones, Siana ; Shun-Shin, Matthew J. ; Cole, Graham D. ; Sau, Arunashis ; March, Katherine ; Williams, Suzanne ; Kyriacou, Andreas ; Hughes, Alun D. ; Mayet, Jamil ; Frenneaux, Michael ; Manisty, Charlotte H. ; Whinnett, Zachary I. ; Francis, Darrel P. / Applicability of the iterative technique for cardiac resynchronization therapy optimization : full-disclosure, 50-sequential-patient dataset of transmitral Doppler traces, with implications for future research design and guidelines. In: Europace. 2014 ; Vol. 16, No. 4. pp. 541-550.
@article{c3feddc620bc4ed09c196cae1dff1ffe,
title = "Applicability of the iterative technique for cardiac resynchronization therapy optimization: full-disclosure, 50-sequential-patient dataset of transmitral Doppler traces, with implications for future research design and guidelines",
abstract = "Full-disclosure study describing Doppler patterns during iterative atrioventricular delay (AVD) optimization of biventricular pacemakers (cardiac resynchronization therapy, CRT).Doppler traces of the first 50 eligible patients undergoing iterative Doppler AVD optimization in the BRAVO trial were examined. Three experienced observers classified conformity to guideline-described patterns. Each observer then selected the optimum AVD on two separate occasions: blinded and unblinded to AVD. Four Doppler E-A patterns occurred: A (always merged, 18 of patients), B (incrementally less fusion at short AVDs, 12), C (full separation at short AVDs, as described by the guidelines, 28), and D (always separated, 42). In Groups A and D (60), the iterative guidelines therefore cannot specify one single AVD. On the kappa scale (0 chance alone; 1 perfect agreement), observer agreement for the ideal AVD in Classes B and C was poor (0.32) and appeared worse in Groups A and D (0.22). Blinding caused the scattering of the AVD selected as optimal to widen (standard deviation rising from 37 to 49 ms, P 0.001). By blinding 28 of the selected optimum AVDs were 60 or 200 ms. All 50 Doppler datasets are presented, to support future methodological testing.In most patients, the iterative method does not clearly specify one AVD. In all the patients, agreement on the ideal AVD between skilled observers viewing identical images is poor. The iterative protocol may successfully exclude some extremely unsuitable AVDs, but so might simply accepting factory default. Irreproducibility of the gold standard also prevents alternative physiological optimization methods from being validated honestly.",
keywords = "atrioventricular delay (AVD), doppler echocardiography, optimization, biventricular pacemaker optimization, chronic heart-failure, atrioventricular delay, follow-up, echocardiography, recommendations, intervals",
author = "Siana Jones and Shun-Shin, {Matthew J.} and Cole, {Graham D.} and Arunashis Sau and Katherine March and Suzanne Williams and Andreas Kyriacou and Hughes, {Alun D.} and Jamil Mayet and Michael Frenneaux and Manisty, {Charlotte H.} and Whinnett, {Zachary I.} and Francis, {Darrel P.}",
note = "This work was supported by the British Heart Foundation (SP/10/002/28189). Published on behalf of the European Society of Cardiology. All rights reserved. {\circledC} The Author 2013.",
year = "2014",
month = "4",
doi = "10.1093/europace/eut257",
language = "English",
volume = "16",
pages = "541--550",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - Applicability of the iterative technique for cardiac resynchronization therapy optimization

T2 - full-disclosure, 50-sequential-patient dataset of transmitral Doppler traces, with implications for future research design and guidelines

AU - Jones, Siana

AU - Shun-Shin, Matthew J.

AU - Cole, Graham D.

AU - Sau, Arunashis

AU - March, Katherine

AU - Williams, Suzanne

AU - Kyriacou, Andreas

AU - Hughes, Alun D.

AU - Mayet, Jamil

AU - Frenneaux, Michael

AU - Manisty, Charlotte H.

AU - Whinnett, Zachary I.

AU - Francis, Darrel P.

N1 - This work was supported by the British Heart Foundation (SP/10/002/28189). Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013.

PY - 2014/4

Y1 - 2014/4

N2 - Full-disclosure study describing Doppler patterns during iterative atrioventricular delay (AVD) optimization of biventricular pacemakers (cardiac resynchronization therapy, CRT).Doppler traces of the first 50 eligible patients undergoing iterative Doppler AVD optimization in the BRAVO trial were examined. Three experienced observers classified conformity to guideline-described patterns. Each observer then selected the optimum AVD on two separate occasions: blinded and unblinded to AVD. Four Doppler E-A patterns occurred: A (always merged, 18 of patients), B (incrementally less fusion at short AVDs, 12), C (full separation at short AVDs, as described by the guidelines, 28), and D (always separated, 42). In Groups A and D (60), the iterative guidelines therefore cannot specify one single AVD. On the kappa scale (0 chance alone; 1 perfect agreement), observer agreement for the ideal AVD in Classes B and C was poor (0.32) and appeared worse in Groups A and D (0.22). Blinding caused the scattering of the AVD selected as optimal to widen (standard deviation rising from 37 to 49 ms, P 0.001). By blinding 28 of the selected optimum AVDs were 60 or 200 ms. All 50 Doppler datasets are presented, to support future methodological testing.In most patients, the iterative method does not clearly specify one AVD. In all the patients, agreement on the ideal AVD between skilled observers viewing identical images is poor. The iterative protocol may successfully exclude some extremely unsuitable AVDs, but so might simply accepting factory default. Irreproducibility of the gold standard also prevents alternative physiological optimization methods from being validated honestly.

AB - Full-disclosure study describing Doppler patterns during iterative atrioventricular delay (AVD) optimization of biventricular pacemakers (cardiac resynchronization therapy, CRT).Doppler traces of the first 50 eligible patients undergoing iterative Doppler AVD optimization in the BRAVO trial were examined. Three experienced observers classified conformity to guideline-described patterns. Each observer then selected the optimum AVD on two separate occasions: blinded and unblinded to AVD. Four Doppler E-A patterns occurred: A (always merged, 18 of patients), B (incrementally less fusion at short AVDs, 12), C (full separation at short AVDs, as described by the guidelines, 28), and D (always separated, 42). In Groups A and D (60), the iterative guidelines therefore cannot specify one single AVD. On the kappa scale (0 chance alone; 1 perfect agreement), observer agreement for the ideal AVD in Classes B and C was poor (0.32) and appeared worse in Groups A and D (0.22). Blinding caused the scattering of the AVD selected as optimal to widen (standard deviation rising from 37 to 49 ms, P 0.001). By blinding 28 of the selected optimum AVDs were 60 or 200 ms. All 50 Doppler datasets are presented, to support future methodological testing.In most patients, the iterative method does not clearly specify one AVD. In all the patients, agreement on the ideal AVD between skilled observers viewing identical images is poor. The iterative protocol may successfully exclude some extremely unsuitable AVDs, but so might simply accepting factory default. Irreproducibility of the gold standard also prevents alternative physiological optimization methods from being validated honestly.

KW - atrioventricular delay (AVD)

KW - doppler echocardiography

KW - optimization

KW - biventricular pacemaker optimization

KW - chronic heart-failure

KW - atrioventricular delay

KW - follow-up

KW - echocardiography

KW - recommendations

KW - intervals

U2 - 10.1093/europace/eut257

DO - 10.1093/europace/eut257

M3 - Article

VL - 16

SP - 541

EP - 550

JO - Europace

JF - Europace

SN - 1099-5129

IS - 4

ER -