Cardiac Resynchronization Therapy Guided by Echocardiography, MRI, and CT Imaging : A Randomized Controlled Study
(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)
(Less)
- author
- Borgquist, Rasmus LU ; Carlsson, Marcus LU ; Markstad, Hanna LU ; Werther-Evaldsson, Anna LU ; Ostenfeld, Ellen LU ; Roijer, Anders LU and Bakos, Zoltan LU
- organization
-
- Arrhytmias and Cardiac Device treatment (research group)
- Clinical studies af Atrial Fibrillation (research group)
- Electrocardiology Research Group - CIEL (research group)
- Cardiology
- Lund Cardiac MR Group (research group)
- Clinical Physiology (Lund)
- Cardiovascular Research - Translational Studies (research group)
- Cardiovascular Research - Epidemiology (research group)
- publishing date
- 2020-10
- 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
-
- pmid:33092758
- scopus:85090061184
- 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
- 2024-06-27 03:05:21
@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}}, }