First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital, Athens, Greece.
First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital, Athens, Greece.
Hellenic J Cardiol. 2022 Jan-Feb;63:8-14. doi: 10.1016/j.hjc.2021.02.012. Epub 2021 Mar 4.
The aim of this study was to assess the capacity of optimized multipoint pacing (MPP) over optimized cardiac resynchronization therapy (CRT), in terms of clinical, functional, and echocardiographic parameters among patients with dyssynchronous heart failure (HF).
Eighty patients (Caucasian, 77.5% male, 68.4 ± 10.1 years, and 53.8% ischemic cardiomyopathy) sequentially received optimized CRT and optimized MPP over 6- and 12-month periods in a single-arm clinical trial. Clinical, laboratory, and echocardiographic assessment was conducted at baseline and after the completion of each step.
Significant additive effects of optimized MPP over optimized CRT were noted with regard to 6-min walking distance (baseline/optCRT/optMPP: 293 ± 120 m vs 367 ± 94 m vs 405 ± 129 m and p < 0.001), NYHA class (2.36 vs 2.19 vs 1.45 and p < 0.001), VTI (14.25 ± 3.2 cm vs 16.2 ± 4 cm vs 17.5 ± 3.4 cm and p < 0.001), stroke volume (48 ± 13.5 ml vs 55 ± 15 ml vs 59 ± 15 ml and p < 0.001), left ventricular ejection fraction (LVEF) (29% ± 7.1% vs 33% ± 7.3% vs 37% ± 7.7% and p < 0.001), maximal left atrial volume (77.2 ± 34.2 ml vs 74.2 ± 39.5 ml vs 67.7 ± 32 ml and p = 0.02), pulmonary artery systolic pressure (35.9 mmHg vs 33.5 mmHg vs 31 mmHg and p < 0.001), and right ventricular strain (-8.3% ± 6.9% vs -8.8% ± 6.6% vs -11.8% ± 6.1% and p = 0.022). With regard to VAC, stroke work (SW), and CP as percentages of maximal, there was a significant difference detected as compared to baseline for both CRT and MPP. Additive effects persisted only if suitable MPP dipoles were present. Exploratory analysis revealed that ischemic cardiomyopathy continued to exhibit significant differences that favor MPP, whereas nonischemic cardiomyopathy had similar findings with regard to total left atrial strain and quality of life.
Optimized MPP showed significant improvements in hemodynamic parameters and ventricular function in patients with HF over optimized CRT. The beneficial effect was more prominent in men and in those with rather reduced LVEF, consistent with findings that suggest a beneficial trend in VAC and CP with more homogeneous depolarization offered by optimized MPP.
本研究旨在评估优化多点起搏（MPP）相对于优化心脏再同步治疗（CRT）在不同心功能失同步心衰患者中的临床、功能和超声心动图参数方面的能力。
80 例患者（白种人，77.5%男性，68.4±10.1 岁，53.8%缺血性心肌病）在一项单臂临床试验中先后接受了 6 个月和 12 个月的优化 CRT 和优化 MPP。在基线和每个步骤完成后进行临床、实验室和超声心动图评估。
与优化 CRT 相比，优化 MPP 具有显著的附加效应，表现为 6 分钟步行距离（基线/optCRT/optMPP：293±120m 比 367±94m 比 405±129m，p<0.001）、NYHA 分级（2.36 比 2.19 比 1.45，p<0.001）、VTI（14.25±3.2cm 比 16.2±4cm 比 17.5±3.4cm，p<0.001）、每搏量（48±13.5ml 比 55±15ml 比 59±15ml，p<0.001）、左心室射血分数（LVEF）（29%±7.1%比 33%±7.3%比 37%±7.7%，p<0.001）、最大左心房容积（77.2±34.2ml 比 74.2±39.5ml 比 67.7±32ml，p=0.02）、肺动脉收缩压（35.9mmHg 比 33.5mmHg 比 31mmHg，p<0.001）和右心室应变（-8.3%±6.9%比-8.8%±6.6%比-11.8%±6.1%，p=0.022）。就 VAC、SW 和 CP 作为最大百分比而言，CRT 和 MPP 均有显著改善。只有在存在合适的 MPP 偶极子的情况下，附加效应才会持续。探索性分析显示，缺血性心肌病继续表现出有利于 MPP 的显著差异，而非缺血性心肌病在总左心房应变和生活质量方面具有相似的发现。
与优化 CRT 相比，优化 MPP 在心衰患者的血液动力学参数和心室功能方面显示出显著改善。这种有益效果在男性和左心室射血分数较低的患者中更为明显，这与 VAC 和 CP 的有益趋势一致，因为优化 MPP 提供了更均匀的去极化。
