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Cardiac Resynchronization Therapy Guided by Echocardiography, MRI, and CT Imaging : A Randomized Controlled Study

Borgquist, Rasmus LU orcid ; Carlsson, Marcus LU ; Markstad, Hanna LU ; Werther-Evaldsson, Anna LU orcid ; Ostenfeld, Ellen LU orcid ; Roijer, Anders LU and Bakos, Zoltan LU (2020) In JACC: Clinical Electrophysiology 6(10). p.1300-1309
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... (More)

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)

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiac CT, cardiac MRI, cardiac resynchronization therapy, echocardiography, heart failure, left ventricular lead position, multimodality imaging
in
JACC: Clinical Electrophysiology
volume
6
issue
10
pages
10 pages
publisher
Elsevier
external identifiers
  • scopus:85090061184
  • pmid:33092758
ISSN
2405-500X
DOI
10.1016/j.jacep.2020.05.011
language
English
LU publication?
yes
id
4227354c-8c8c-467a-af3b-628c4d42356c
date added to LUP
2020-09-25 09:01:48
date last changed
2024-05-30 22:35:19
@article{4227354c-8c8c-467a-af3b-628c4d42356c,
  abstract     = {{<p>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)</p>}},
  author       = {{Borgquist, Rasmus and Carlsson, Marcus and Markstad, Hanna and Werther-Evaldsson, Anna and Ostenfeld, Ellen and Roijer, Anders and Bakos, Zoltan}},
  issn         = {{2405-500X}},
  keywords     = {{cardiac CT; cardiac MRI; cardiac resynchronization therapy; echocardiography; heart failure; left ventricular lead position; multimodality imaging}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1300--1309}},
  publisher    = {{Elsevier}},
  series       = {{JACC: Clinical Electrophysiology}},
  title        = {{Cardiac Resynchronization Therapy Guided by Echocardiography, MRI, and CT Imaging : A Randomized Controlled Study}},
  url          = {{http://dx.doi.org/10.1016/j.jacep.2020.05.011}},
  doi          = {{10.1016/j.jacep.2020.05.011}},
  volume       = {{6}},
  year         = {{2020}},
}