Osca Joaquín, Francisco-Pascual Jaume, Martínez-Basterra Javier, Martínez Juan Gabriel, Reis Hipólito, Oliveira Mario, Campos Bieito, Balaguer Javier, Rubio Jerónimo, Pavón-Jiménez Ricardo, Hernández Julio, Ormaetxe Jose Miguel, Zamorano Jose Luis, Santamaría Pilar, Alzueta Javier
Hospital Universitari i Politecnic La Fe, Valencia, Spain.
Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain.
Eur J Clin Invest. 2023 Apr;53(4):e13935. doi: 10.1111/eci.13935. Epub 2022 Dec 29.
Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate.
To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant.
This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort.
Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%.
Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.
尽管心脏再同步治疗（CRT）对大多数心力衰竭患者有益，但高达40%的患者对CRT无反应。有人提出多点左心室起搏（MPP）可提高反应率。
评估植入具有MPP功能且在植入后早期激活该功能的CRT装置的患者6个月时的CRT反应率。
这是一项多中心、前瞻性、开放标签且非随机的研究。主要终点是双心室起搏反应，定义为通过核心实验室比较基线和6个月时超声心动图测量结果，左心室收缩末期容积（LVESV）相对减少>15%。在次要终点中，评估了死亡率或全因住院的联合终点。将主要研究终点和临床结果与Quarto II对照队列进行比较。
共纳入105例患者。反应率为64.6%（97.5%置信下限为53%）。LVESV的平均相对减少率为25.3%，左心室射血分数（LVEF）的平均绝对增加率为9.4%。采用解剖学方法进行设备程控的受试者的反应率有高于采用电学方法者的趋势（72%对61.1%，p = 0.32）。最后，6个月时死亡率和/或全因住院的联合发生率为12.4%。
在随访6个月时，早期激活MPP与增加CRT的超声心动图反应者优势无关。然而，使用最宽起搏阴极进行程控的患者反应率在数值上更高。最后，早期激活MPP与随访6个月时临床终点的低发生率相关。
