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@article{Whinnett:2019:10.1016/j.jcmg.2018.02.014,
author = {Whinnett, Z and Sohaib, SMA and Mason, M and Duncan, E and Tanner, M and Lefroy, D and Al-Obaidi, M and Ellery, S and Leyva-Leon, F and Betts, T and Dayer, M and Foley, P and Swinburn, J and Thomas, M and Khiani, R and Wong, T and Yousef, Z and Rogers, D and Kalra, P and Dhileepan, V and March, K and Howard, J and Kyriacou, A and Mayet, J and Kanagaratnam, P and Frenneaux, M and Hughes, A and Francis, D},
doi = {10.1016/j.jcmg.2018.02.014},
journal = {JACC: Cardiovascular Imaging},
pages = {1407--1416},
title = {Multicenter randomized controlled crossover trial comparing hemodynamic optimization against echocardiographic optimization of AV and VV delay of Cardiac Resynchronization Therapy: The BRAVO Trial},
url = {http://dx.doi.org/10.1016/j.jcmg.2018.02.014},
volume = {12},
year = {2019}
}

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TY  - JOUR
AB  - ObjectivesBRAVO (British Randomized Controlled Trial of AV and VV Optimization) is a multicenter, randomized, crossover, noninferiority trial comparing echocardiographic optimization of atrioventricular (AV) and interventricular delay with a noninvasive blood pressure method.BackgroundCardiac resynchronization therapy including AV delay optimization confers clinical benefit, but the optimization requires time and expertise to perform.MethodsThis study randomized patients to echocardiographic optimization or hemodynamic optimization using multiple-replicate beat-by-beat noninvasive blood pressure at baseline; after 6 months, participants were crossed over to the other optimization arm of the trial. The primary outcome was exercise capacity, quantified as peak exercise oxygen uptake. Secondary outcome measures were echocardiographic left ventricular (LV) remodeling, quality-of-life scores, and N-terminal pro–B-type natriuretic peptide.ResultsA total of 401 patients were enrolled, the median age was 69 years, 78% of patients were men, and the New York Heart Association functional class was II in 84% and III in 16%. The primary endpoint, peak oxygen uptake, met the criterion for noninferiority (pnoninferiority = 0.0001), with no significant difference between the hemodynamically optimized arm and echocardiographically optimized arm of the trial (mean difference 0.1 ml/kg/min). Secondary endpoints for noninferiority were also met for symptoms (mean difference in Minnesota score 1; pnoninferiority = 0.002) and hormonal changes (mean change in N-terminal pro–B-type natriuretic peptide -10 pg/ml; pnoninferiority = 0.002). There was no significant difference in LV size (mean change in LV systolic dimension 1 mm; pnoninferiority < 0.001; LV diastolic dimension 0 mm; pnoninferiority <0.001). In 30% of patients the AV delay identified as optimal was more than 20 ms from the nominal setting of 120 ms.ConclusionsOptimization of cardiac resynchronization therapy
AU  - Whinnett,Z
AU  - Sohaib,SMA
AU  - Mason,M
AU  - Duncan,E
AU  - Tanner,M
AU  - Lefroy,D
AU  - Al-Obaidi,M
AU  - Ellery,S
AU  - Leyva-Leon,F
AU  - Betts,T
AU  - Dayer,M
AU  - Foley,P
AU  - Swinburn,J
AU  - Thomas,M
AU  - Khiani,R
AU  - Wong,T
AU  - Yousef,Z
AU  - Rogers,D
AU  - Kalra,P
AU  - Dhileepan,V
AU  - March,K
AU  - Howard,J
AU  - Kyriacou,A
AU  - Mayet,J
AU  - Kanagaratnam,P
AU  - Frenneaux,M
AU  - Hughes,A
AU  - Francis,D
DO  - 10.1016/j.jcmg.2018.02.014
EP  - 1416
PY  - 2019///
SN  - 1936-878X
SP  - 1407
TI  - Multicenter randomized controlled crossover trial comparing hemodynamic optimization against echocardiographic optimization of AV and VV delay of Cardiac Resynchronization Therapy: The BRAVO Trial
T2  - JACC: Cardiovascular Imaging
UR  - http://dx.doi.org/10.1016/j.jcmg.2018.02.014
UR  - http://hdl.handle.net/10044/1/58311
VL  - 12
ER  -

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