Targeting the latest site of left ventricular mechanical activation is associated with improved long-term outcomes for recipients of cardiac resynchronization therapy
Borgquist, Rasmus LU
; Barrington, William R.
; Bakos, Zoltan
LU
; Werther-Evaldsson, Anna
LU
and Saba, Samir
(2022)
In Heart Rhythm O2
3(4).
p.377-384
- Abstract
Background: Previous studies have suggested that targeting the site of latest mechanical activation of the left ventricle (LV) results in improved cardiac resynchronization therapy (CRT) outcomes. It is not known whether these benefits are sustained over medium-term follow-up. Objective: To assess the clinical outcome of imaging-guided LV lead position. Methods: We sought to assess the medium-term clinical outcome by performing a patient-level meta-analysis of 2 previously published randomized controlled trials (the “STARTER” trial and the “CRT Clinic” trial). These 2 trials compared imaging-guided LV lead placement in the latest activated scar-free segment (intervention group) to standard of care (control). Mortality and heart failure... (More)
Background: Previous studies have suggested that targeting the site of latest mechanical activation of the left ventricle (LV) results in improved cardiac resynchronization therapy (CRT) outcomes. It is not known whether these benefits are sustained over medium-term follow-up. Objective: To assess the clinical outcome of imaging-guided LV lead position. Methods: We sought to assess the medium-term clinical outcome by performing a patient-level meta-analysis of 2 previously published randomized controlled trials (the “STARTER” trial and the “CRT Clinic” trial). These 2 trials compared imaging-guided LV lead placement in the latest activated scar-free segment (intervention group) to standard of care (control). Mortality and heart failure hospitalization outcomes over extended follow-up were gathered from the medical records and merged. Results were stratified for native electrocardiogram (ECG) morphology. Results: A total of 289 patients were followed for a median of 6.3 years. Seven years post implant, 47 (28%) in the intervention group had died, vs 47 (38%) in the control group (P = .13); 49 (30%) vs 53 (42%) had been hospitalized for heart failure (P = .035); and 47% vs 59% (P = .057) had reached the combined endpoint. In Kaplan-Meier analysis, patients in the intervention group had better survival free of heart failure hospitalization (P = .045) and lower risk of heart failure hospitalization (P = .019). Conclusion: Targeting the latest mechanically activated segment in CRT results in better medium-term clinical outcome, mainly driven by a reduced risk of hospitalization for heart failure. The effect was seen regardless of native ECG morphology.
(Less)
- author
- Borgquist, Rasmus
LU
; Barrington, William R.
; Bakos, Zoltan
LU
; Werther-Evaldsson, Anna
LU
and Saba, Samir
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiac resynchronization therapy, Heart failure hospitalization, Latest mechanical activation, Mortality
- in
- Heart Rhythm O2
- volume
- 3
- issue
- 4
- pages
- 377 - 384
- publisher
- Elsevier
- external identifiers
-
- pmid:36097466
- scopus:85131835459
- DOI
- 10.1016/j.hroo.2022.05.003
- language
- English
- LU publication?
- yes
- additional info
- Funding Information: This work was supported by an ALF grant (R.B.) within the Swedish National Health Care system . Publisher Copyright: © Heart Rhythm Society
- id
- 86cdbbe6-7b33-4943-9f2d-d22bc687c76e
- date added to LUP
- 2022-06-26 10:50:04
- date last changed
- 2025-06-14 03:55:10
@article{86cdbbe6-7b33-4943-9f2d-d22bc687c76e,
abstract = {{<p>Background: Previous studies have suggested that targeting the site of latest mechanical activation of the left ventricle (LV) results in improved cardiac resynchronization therapy (CRT) outcomes. It is not known whether these benefits are sustained over medium-term follow-up. Objective: To assess the clinical outcome of imaging-guided LV lead position. Methods: We sought to assess the medium-term clinical outcome by performing a patient-level meta-analysis of 2 previously published randomized controlled trials (the “STARTER” trial and the “CRT Clinic” trial). These 2 trials compared imaging-guided LV lead placement in the latest activated scar-free segment (intervention group) to standard of care (control). Mortality and heart failure hospitalization outcomes over extended follow-up were gathered from the medical records and merged. Results were stratified for native electrocardiogram (ECG) morphology. Results: A total of 289 patients were followed for a median of 6.3 years. Seven years post implant, 47 (28%) in the intervention group had died, vs 47 (38%) in the control group (P = .13); 49 (30%) vs 53 (42%) had been hospitalized for heart failure (P = .035); and 47% vs 59% (P = .057) had reached the combined endpoint. In Kaplan-Meier analysis, patients in the intervention group had better survival free of heart failure hospitalization (P = .045) and lower risk of heart failure hospitalization (P = .019). Conclusion: Targeting the latest mechanically activated segment in CRT results in better medium-term clinical outcome, mainly driven by a reduced risk of hospitalization for heart failure. The effect was seen regardless of native ECG morphology.</p>}},
author = {{Borgquist, Rasmus and Barrington, William R. and Bakos, Zoltan and Werther-Evaldsson, Anna and Saba, Samir}},
keywords = {{Cardiac resynchronization therapy; Heart failure hospitalization; Latest mechanical activation; Mortality}},
language = {{eng}},
number = {{4}},
pages = {{377--384}},
publisher = {{Elsevier}},
series = {{Heart Rhythm O2}},
title = {{Targeting the latest site of left ventricular mechanical activation is associated with improved long-term outcomes for recipients of cardiac resynchronization therapy}},
url = {{http://dx.doi.org/10.1016/j.hroo.2022.05.003}},
doi = {{10.1016/j.hroo.2022.05.003}},
volume = {{3}},
year = {{2022}},
}