Rasmus Borgquist1, Marcus Carlsson2, Hanna Markstad3, Anna Werther-Evaldsson4, Ellen Ostenfeld5, Anders Roijer4, Zoltan Bakos6. 1. Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden. Electronic address: rasmus.borgquist@med.lu.se. 2. Clinical Physiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden. 3. Radiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden. 4. Heart Failure and Valvular Heart Disease Section, Skane University Hospital, Lund, Sweden. 5. Clinical Physiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden; Radiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden. 6. Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden.
Abstract
OBJECTIVES: This study evaluated if selecting the left ventricular (LV) target segment by echocardiography-derived late mechanical activation, with access to multimodality imaging for scar and venous anatomy, could help to increase responder rates to cardiac resynchronization therapy (CRT). BACKGROUND: LV lead placement is important for clinical outcome, but the optimal strategy for LV lead placement in CRT is still debated. METHODS: This study conducted a prospective, blinded randomized controlled trial on 102 patients with indication for CRT (27% women, 46% with ischemic cardiomyopathy, 63% in New York Heart Association functional class III, 74% with left bundle branch block, and with mean ejection fraction of 23%). Optimal LV lead location was defined as the latest mechanically activated available segment (free of transmural scar), determined by radial strain echocardiography, cardiac computed tomography, and cardiac magnetic resonance (n = 70). The primary endpoint was reduction of LV end-systolic volume by ≥15% at 6 months post-implantation. RESULTS: Patients were followed for 47 ± 21 months. Based on imaging, optimal or adjacent lead placement was feasible in 96% of all cases and was obtained in 83% of the intervention group versus 80% of the control group. Fifty-six percent of the patients were LV end-systolic volume responders compared with the control group (55%) (p = 0.96), and 71% improved ≥1 New York Heart Association functional class (74% vs. 67%; p = 0.43). Death or heart failure hospitalization within 2 years occurred in 6% (2% of the intervention group vs. 10% of the control group; p = 0.07). CONCLUSIONS: Radial strain-guided LV lead placement, in combination with multimodality imaging, did not result in increased clinical or echocardiographic response, nor in a significant reduction of death or heart failure hospitalization. (Combining Myocardial Strain and Cardiac CT to Optimize Left Ventricular Lead Placement in CRT Treatment [CRT Clinic]; NCT01426321).
RCT Entities:
OBJECTIVES: This study evaluated if selecting the left ventricular (LV) target segment by echocardiography-derived late mechanical activation, with access to multimodality imaging for scar and venous anatomy, could help to increase responder rates to cardiac resynchronization therapy (CRT). BACKGROUND: LV lead placement is important for clinical outcome, but the optimal strategy for LV lead placement in CRT is still debated. METHODS: This study conducted a prospective, blinded randomized controlled trial on 102 patients with indication for CRT (27% women, 46% with ischemic cardiomyopathy, 63% in New York Heart Association functional class III, 74% with left bundle branch block, and with mean ejection fraction of 23%). Optimal LV lead location was defined as the latest mechanically activated available segment (free of transmural scar), determined by radial strain echocardiography, cardiac computed tomography, and cardiac magnetic resonance (n = 70). The primary endpoint was reduction of LV end-systolic volume by ≥15% at 6 months post-implantation. RESULTS:Patients were followed for 47 ± 21 months. Based on imaging, optimal or adjacent lead placement was feasible in 96% of all cases and was obtained in 83% of the intervention group versus 80% of the control group. Fifty-six percent of the patients were LV end-systolic volume responders compared with the control group (55%) (p = 0.96), and 71% improved ≥1 New York Heart Association functional class (74% vs. 67%; p = 0.43). Death or heart failure hospitalization within 2 years occurred in 6% (2% of the intervention group vs. 10% of the control group; p = 0.07). CONCLUSIONS: Radial strain-guided LV lead placement, in combination with multimodality imaging, did not result in increased clinical or echocardiographic response, nor in a significant reduction of death or heart failure hospitalization. (Combining Myocardial Strain and Cardiac CT to Optimize Left Ventricular Lead Placement in CRT Treatment [CRT Clinic]; NCT01426321).
Authors: Björn Östenson; Ellen Ostenfeld; Anna Werther-Evaldsson; Anders Roijer; Zoltan Bakos; Mikael Kanski; Einar Heiberg; Håkan Arheden; Rasmus Borgquist; Marcus Carlsson Journal: BMC Cardiovasc Disord Date: 2021-10-26 Impact factor: 2.298