Future research prioritization in cardiac resynchronization therapy

Fudim, Marat; Dalgaard, Frederik; Al‐Khatib, Sana M.; Friedman, Daniel J.; Lallinger, Kathryn R; Abraham, William T.; Cleland, John G.F.; Curtis, Anne B.; Gold, Michael R.; Kutyifa, Valentina; Linde, Cecilia; Schaber, Daniel E.; Tang, Anthony; Ali‐Ahmed, Fatima; Goldstein, S.; Kaufman, Brystana G.; Fortman, Robyn; Davis, J. Kelly; Inoue, Lurdes Y.T.; Sanders, Gillian D

doi:10.1016/j.ahj.2020.02.011

Cited by 14 publications

(16 citation statements)

References 43 publications

(37 reference statements)

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“…Once the biomarker is established, one may search for less invasive alternatives to replace the method with similar robust and operator‐independent markers; however, non‐invasive surrogates are likely less robust and less accurate to deliver what is required as a basis for critical clinical decisions regarding CRT. More effective therapy resulting from the measurement of Td in patients could promote cost‐effectiveness and CRT utilization and help close existing knowledge gaps in the current CRT practice 2,47 . We have shown how a prolonged Td and shortening with resynchronization therapy identifies patients with long‐term beneficial effects from CRT in a homogeneous group of patients.…”

Section: Discussionmentioning

confidence: 95%

“…More effective therapy resulting from the measurement of Td in patients could promote cost‐effectiveness and CRT utilization and help close existing knowledge gaps in the current CRT practice. 2 , 47 We have shown how a prolonged Td and shortening with resynchronization therapy identifies patients with long‐term beneficial effects from CRT in a homogeneous group of patients. It seems even more critical to identify volumetric responders among patients with an ischaemic myocardial disease and intraventricular conduction delays with a lower responder rate.…”

Section: Discussionmentioning

confidence: 99%

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Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

et al. 2021

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AimsWe tested the hypothesis that shortening of time-to-peak left ventricular pressure rise (Td) reflect resynchronization in an animal model and that Td measured in patients will be helpful to identify long-term volumetric responders [end-systolic volume (ESV) decrease >15%] in cardiac resynchronization therapy (CRT). Methods Td was analysed in an animal study (n = 12) of left bundle-branch block (LBBB) with extensive instrumentation to detect left ventricular myocardial deformation, electrical activation, and pressures during pacing. The sum of electrical delays from the onset of pacing to four intracardiac electrodes formed a synchronicity index (SI). Pacing was performed at baseline, with LBBB, right and left ventricular pacing and finally with biventricular pacing (BIVP). We then studied Td at baseline and with BIVP in a clinical observational study in 45 patients during the implantation of CRT and followed up for up to 88 months. ResultsWe found a strong relationship between Td and SI in the animals (R = 0.84, P < 0.01). Td and SI increased from narrow QRS at baseline (Td = 95 ± 2 ms, SI = 141 ± 8 ms) to LBBB (Td = 125 ± 2 ms, SI = 247 ± 9 ms, P < 0.01), and shortened with biventricular pacing (BIVP) (Td = 113 ± 2 ms and SI = 192 ± 7 ms, P < 0.01). Prolongation of Td was associated with more wasted deformation during the preejection period (R = 0.77, P < 0.01). Six patients increased ESV by 2.5 ± 18%, while 37 responders (85%) had a mean ESV decrease of 40 ± 15% after more than 6 months of follow-up. Responders presented with a higher Td at baseline than non-responders (163 ± 26 ms vs. 121 ± 19 ms, P < 0.01). Td decreased to 156 ± 16 ms (P = 0.02) with CRT in responders, while in non-responders, Td increased to 148 ± 21 ms (P < 0.01). A decrease in Td with BIVP to values similar or below what was found at baseline accurately identified responders to therapy (AUC 0.98, P < 0.01). Td at baseline and change in Td from baseline was linear related to the decrease in ESV at follow-up. All-cause mortality was high among six non-responders (n = 4), while no patients died in the responder group during follow-up. Conclusions Prolongation of Td is associated with cardiac dyssynchrony and more wasted deformation during the preejection period. Shortening of a prolonged Td with CRT in patients accurately identifies volumetric responders to CRT with incremental value on top of current guidelines and practices. Thus, Td carries the potential to become a biomarker to predict long-term volumetric response in CRT candidates.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

et al. 2021

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“…This review was conducted as part of a National Heart, Lung, and Blood Institute-funded project to synthesize evidence related to CRT and to identify and prioritize clinical and policy evidence gaps [ 12 ]. To address one component of the evidence gap regarding the extent and/or location of LV mechanical dyssynchrony predicting CRT outcomes, we conducted a systematic literature review for studies evaluating CRT outcomes in patients with an image-guided approach for LV lead placement within the LV segment with the latest mechanical activation versus a non-image-guided approach.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis

LaPointe

Ahmed

Dalgaard

et al. 2022

Journal of Interventional Cardiology

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Aim. To assess evidence for an image-guided approach for cardiac resynchronization therapy (CRT) that targets left ventricular (LV) lead placement at the segment of latest mechanical activation. Methods. A systematic review of EMBASE and PubMed was performed for randomized controlled trials (RCTs) and prospective observational studies from October 2008 through October 2020 that compared an image-guided CRT approach with a non-image-guided approach for LV lead placement. Meta-analyses were performed to assess the association between the image-guided approach and NYHA class improvement or changes in end-systolic volume (LVESV), end-diastolic volume (LVEDV), and ejection fraction (LVEF). Results. From 5897 citations, 5 RCTs including 818 patients (426 image-guided and 392 non-image-guided) were identified. The mean age ranged from 66 to 71 years, 76% were male, and 53% had ischemic cardiomyopathy. Speckle tracking echocardiography was the primary image-guided method in all studies. LV lead placement within the segment of the latest mechanical activation (concordant) was achieved in the image-guided arm in 45% of the evaluable patients. There was a statistically significant improvement in the NYHA class at 6 months (odds ratio 1.66; 95% confidence interval (CI) [1.02, 2.69]) with the image-guided approach, but no statistically significant change in LVESV (MD −7.1%; 95% CI [−16.0, 1.8]), LVEDV (MD −5.2%; 95% CI [−15.8, 5.4]), or LVEF (MD 0.68; 95% CI [−4.36, 5.73]) versus the non-image-guided approach. Conclusion. The image-guided CRT approach was associated with improvement in the NYHA class but not echocardiographic measures, possibly due to the small sample size and a low rate of concordant LV lead placement despite using the image-guided approach. Therefore, our meta-analysis was not able to identify consistent improvement in CRT outcomes with an image-guided approach.

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“…Additionally, in a 2020 review of CRT research a panel of experts examined the existing clinical data related to CRT effectiveness in patients with heart failure with reduced J o u r n a l P r e -p r o o f 6 ejection fraction (HFrEF) and identified several evidence gaps related to CRT. 12 Two of the top tier gaps related to the effectiveness of CRT among patients with paroxysmal, persistent and permanent AF and the association and role of atrioventricular (AV) node ablation on CRT effectiveness.…”

Section: Prior Studies Of Crt In Af Patientsmentioning

confidence: 99%

Atrial fibrillation associated with heart failure treated by a 2-lead CRT-DX system (BIO-AffectDX): Study design and clinical protocol

et al. 2021

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Future research prioritization in cardiac resynchronization therapy

Cited by 14 publications

References 43 publications

Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis

Atrial fibrillation associated with heart failure treated by a 2-lead CRT-DX system (BIO-AffectDX): Study design and clinical protocol

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