TY - JOUR
T1 - Imaging-guided cardiac resynchronization therapy
T2 - A meta-analysis of randomized controlled trials
AU - Kheiri, Babikir
AU - Przybylowicz, Ryle
AU - Simpson, Timothy F.
AU - Merrill, Miranda
AU - Osman, Mohammed
AU - Dalouk, Khidir
AU - Rahmouni, Hind
AU - Stecker, Eric
AU - Nazer, Babak
AU - Henrikson, Charles A.
N1 - Publisher Copyright:
© 2021 Wiley Periodicals LLC
PY - 2021/9
Y1 - 2021/9
N2 - Background: Among patients with heart failure and left ventricular (LV) dysfunction despite guideline directed medical therapy, cardiac resynchronization (CRT) is an effective technology to reverse LV remodeling. Given that a large portion of patients are non-responders, alternatives to traditional LV-lead placement have been explored. A promising alternative is image targeted placement of an LV-lead to latest mechanically activated segment without scar. Methods: Electronic database search for randomized controlled trials (RCTs) that evaluated the imaging-guided LV-lead placement on clinical, echocardiographic, and functional outcomes. The primary outcome was a composite of mortality and heart failure hospitalization. The secondary outcomes included CRT responders, New York Heart Association (NYHA), 6-minute walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and ejection fraction (EF) changes. Results: Analysis included 4 RCTs of 691 patients with an average follow-up of 2 years (age 69.5 ± 10.3 years, 76% males, 54% ischemic cardiomyopathy, 81% with NYHA classes III/IV, and EF of 24.4% ± 8). The most common site for LV-lead paced segment was the anterolateral segment (45%) and at mid-LV (49%). Compared with the control, imaging-guided LV-lead placement was associated with a significant reduction of the primary outcome (hazard ratio [HR] = 0.60; 95% CI = 0.40–0.88; p =.01), higher CRT responders (odd ratio [OR] = 2.10; p <.01), more NYHA improvements by ≥1 (OR = 1.89; p =.01), increased 6MWT (mean difference [MD] = 25.78 feet; p <.01), and lower MLHFQ (MD = -4.04; p =.04), without significant differences in the LVEF (p =.08). Conclusions: In patients undergoing CRT, imaging-guided LV-lead placement was associated with improved clinical, echocardiographic, and functional status.
AB - Background: Among patients with heart failure and left ventricular (LV) dysfunction despite guideline directed medical therapy, cardiac resynchronization (CRT) is an effective technology to reverse LV remodeling. Given that a large portion of patients are non-responders, alternatives to traditional LV-lead placement have been explored. A promising alternative is image targeted placement of an LV-lead to latest mechanically activated segment without scar. Methods: Electronic database search for randomized controlled trials (RCTs) that evaluated the imaging-guided LV-lead placement on clinical, echocardiographic, and functional outcomes. The primary outcome was a composite of mortality and heart failure hospitalization. The secondary outcomes included CRT responders, New York Heart Association (NYHA), 6-minute walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and ejection fraction (EF) changes. Results: Analysis included 4 RCTs of 691 patients with an average follow-up of 2 years (age 69.5 ± 10.3 years, 76% males, 54% ischemic cardiomyopathy, 81% with NYHA classes III/IV, and EF of 24.4% ± 8). The most common site for LV-lead paced segment was the anterolateral segment (45%) and at mid-LV (49%). Compared with the control, imaging-guided LV-lead placement was associated with a significant reduction of the primary outcome (hazard ratio [HR] = 0.60; 95% CI = 0.40–0.88; p =.01), higher CRT responders (odd ratio [OR] = 2.10; p <.01), more NYHA improvements by ≥1 (OR = 1.89; p =.01), increased 6MWT (mean difference [MD] = 25.78 feet; p <.01), and lower MLHFQ (MD = -4.04; p =.04), without significant differences in the LVEF (p =.08). Conclusions: In patients undergoing CRT, imaging-guided LV-lead placement was associated with improved clinical, echocardiographic, and functional status.
KW - cardiac CT
KW - cardiac MRI
KW - cardiac resynchronization therapy
KW - cardiomyopathy
KW - echocardiography
KW - heart failure
KW - left ventricular lead position
KW - multimodality imaging
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U2 - 10.1111/pace.14316
DO - 10.1111/pace.14316
M3 - Article
C2 - 34255376
AN - SCOPUS:85110952641
SN - 0147-8389
VL - 44
SP - 1570
EP - 1576
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
IS - 9
ER -