Department of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
Department of Cardiology, Papworth Hospital, Cambridge, United Kingdom.
JACC Heart Fail. 2014 Jun;2(3):205-12. doi: 10.1016/j.jchf.2013.11.010.
This study was conducted to assess the impact of left ventricular (LV) lead position on longer-term survival after cardiac resynchronization therapy (CRT).
An optimal LV lead position in CRT is associated with improved clinical outcome. A strategy of speckle-tracking echocardiography can be used to guide the implanter to the site of latest activation and away from segments of low strain amplitude (scar). Long-term, prospective survival data according to LV lead position in CRT are limited.
Data from a follow-up registry of 250 consecutive patients receiving CRT between June 2008 and July 2010 were studied. The study population comprised patients recruited to the derivation group and the subsequent TARGET (Targeted Left Ventricular Lead Placement to guide Cardiac Resynchronization Therapy) randomized, controlled trial. Final LV lead position was described, in relation to the pacing site determined by pre-procedure speckle-tracking echocardiography, as optimal (concordant/adjacent) or suboptimal (remote). All-cause mortality was recorded at follow-up.
An optimal LV lead position (n = 202) conferred LV remodeling response superior to that of a suboptimal lead position (change in LV end-systolic volume: -24 ± 15% vs. -12 ± 17% [p < 0.001]; change in ejection fraction: +7 ± 8% vs. +4 ± 7% [p = 0.02]). During long-term follow-up (median: 39 months; range: <1 to 61 months), an optimal LV lead position was associated with improved survival (log-rank p = 0.003). A suboptimal LV lead placement independently predicted all-cause mortality (hazard ratio: 1.8; p = 0.024).
An optimal LV lead position at the site of latest mechanical activation, avoiding low strain amplitude (scar), was associated with superior CRT response and improved survival that persisted during follow-up.
本研究旨在评估左心室（LV）导线位置对心脏再同步治疗（CRT）后长期生存的影响。
CRT 中 LV 导线的最佳位置与改善临床结果相关。斑点追踪超声心动图策略可用于指导植入者将导线放置在最晚激活部位，并远离低应变幅度（瘢痕）区域。根据 CRT 中 LV 导线位置的长期前瞻性生存数据有限。
研究纳入了 2008 年 6 月至 2010 年 7 月期间连续接受 CRT 的 250 例患者的随访登记数据。该研究人群包括来自于推导组和随后的 TARGET（靶向左心室导线放置指导心脏再同步治疗）随机对照试验的患者。最终 LV 导线位置与术前斑点追踪超声心动图确定的起搏部位相关，分为最佳（一致/毗邻）或次优（远程）。在随访时记录全因死亡率。
LV 导线的最佳位置（n=202）与次优位置相比，LV 重构反应更好（LV 收缩末期容积变化：-24±15%比-12±17%[p<0.001]；射血分数变化：+7±8%比+4±7%[p=0.02]）。在长期随访（中位：39 个月；范围：<1 至 61 个月）中，LV 导线的最佳位置与生存率的提高相关（对数秩检验 p=0.003）。LV 导线的次优位置独立预测全因死亡率（风险比：1.8；p=0.024）。
LV 导线位于最晚机械激活部位、避开低应变幅度（瘢痕）区域，与 CRT 反应更好和生存改善相关，且在随访期间持续存在。
