Department of Cardiology, Gentofte University Hospital, Gentofte, Denmark.
J Am Soc Echocardiogr. 2010 Jun;23(6):621-7. doi: 10.1016/j.echo.2010.04.006.
In studies showing benefits of cardiac resynchronization therapy (CRT), individual atrioventricular (AV) delays have been optimized using echocardiography. However, the method for AV delay optimization remains controversial.
In 100 consecutive patients with CRT device implantation, AV delay was optimized using echocardiography. The optimal AV delay was determined by changing the interval in 20-ms increments while measuring displacement in 6 basal left ventricular segments (averaged and reported as left ventricular displacement [D(LV)]) and other echocardiographic measures.
A single optimal AV delay existed for each patient, and the associated highest D(LV) corresponded with the maximal velocity-time integral (VTI) in the left ventricular outflow tract (VTI(LVOT)) and the E/e' ratio. Significant increases in D(LV) and the VTI(LVOT) from before to after implantation with standard settings and from standard to optimal AV delay by displacement were found. Diastolic filling time corresponded poorly with D(LV) and the VTI(LVOT).
Individual optimal AV delay programming provides significant improvement in left ventricular performance and hemodynamics. Displacement analysis and the VTI(LVOT) are interchangeable, whereas diastolic filling time cannot be recommended.
在显示心脏再同步治疗（CRT）益处的研究中，已经使用超声心动图优化了个体房室（AV）延迟。然而，AV 延迟优化的方法仍然存在争议。
在 100 例连续接受 CRT 设备植入的患者中，使用超声心动图优化了 AV 延迟。通过以 20ms 的增量改变间隔，同时测量 6 个基底左心室节段的位移（平均并报告为左心室位移[D（LV）]）和其他超声心动图指标，确定最佳 AV 延迟。
每位患者存在单个最佳 AV 延迟，与左心室流出道（LVOT）最大速度时间积分（VTI）和 E/e' 比值对应的最高 D（LV）相关。在标准设置下，从植入前到植入后的 D（LV）和 LVOT 明显增加，从标准 AV 延迟到最佳 AV 延迟的位移也明显增加。舒张充盈时间与 D（LV）和 LVOT 相关性差。
个体最佳 AV 延迟编程可显著改善左心室功能和血液动力学。位移分析和 LVOT 可互换，而舒张充盈时间不能推荐。
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