Leclercq Christophe, Burri Haran, Calò Leonardo, Rinaldi Christopher Aldo, Sperzel Johannes, Thibault Bernard, Betts Tim, Defaye Pascal, Hain Andreas, Piot Olivier, Lee Kwangdeok, Lin Wenjiao, Pollastrelli Annalisa, Grammatico Andrea, Boriani Giuseppe
Service de Cardiologie et Maladies Vasculaires, rue Henri le Guilloux 35033 Rennes Cédex 09, CHRU Hopital de Pontchaillou, Rennes, France.
Département de Cardiologie, Hôpital Cantonal Universitaire de Geneva, Geneva, Switzerland.
Europace. 2025 Jun 3;27(6). doi: 10.1093/europace/euaf070.
Cardiac resynchronization therapy (CRT) via biventricular pacing (BIVP) is an effective treatment, but non-responders are at a higher risk of death and heart failure (HF) hospitalizations compared with CRT responders. The MORE-CRT MPP trial aimed to evaluate whether CRT with multipoint pacing (MPP) is associated with improved clinical outcomes in CRT non-responders.
Cardiac resynchronization therapy patients were treated with conventional BIVP for 6 months and then assessed for CRT response (left ventricular end-systolic volume relative reduction >15% vs. baseline). Cardiac resynchronization therapy non-responders were 1:1 randomized to BIVP or MPP and followed for 6 months. The main endpoint of this secondary analysis was HF hospitalizations or all-cause mortality. Of 3724 CRT patients (67 ± 11 years, 1050 female), 1677 were non-responders and randomized to MPP or BIVP, of whom 1421 (722 MPP and 699 BIVP) had complete data. In a mean follow-up of 5 ± 1 months after randomization, MPP was associated with a lower incidence of HF hospitalizations or all-cause mortality [48/722 (6.64%)] compared with BIVP (73/699 (10.44%), RRR = 36% (95% CI=±4%), P = 0.0107). At multivariable analysis, MPP was associated with a lower occurrence of the main endpoint (odds ratio = 0.60, P = 0.0124). At logistic regression analysis, HF hospitalizations or all-cause death were lower with MPP vs. BIVP in the whole population and in many patients subgroups, e.g. ischaemic patients and patients with long (>105 ms) interventricular electrical delay.
In the MORE-CRT MPP randomized trial, MPP was associated with a significant reduction of all-cause mortality and HF hospitalizations in prior non-responders to conventional biventricular pacing.
通过双心室起搏（BIVP）进行心脏再同步治疗（CRT）是一种有效的治疗方法，但与CRT反应者相比，无反应者的死亡风险和心力衰竭（HF）住院风险更高。MORE-CRT MPP试验旨在评估多点起搏（MPP）的CRT是否能改善CRT无反应者的临床结局。
心脏再同步治疗患者接受传统BIVP治疗6个月，然后评估CRT反应（左心室收缩末期容积相对于基线减少>15%）。CRT无反应者按1:1随机分为BIVP或MPP组，并随访6个月。该二次分析的主要终点是HF住院或全因死亡率。在3724例CRT患者（67±11岁，1050例女性）中，1677例为无反应者，随机分为MPP或BIVP组，其中1421例（722例MPP和699例BIVP）有完整数据。在随机分组后的平均5±1个月随访中，与BIVP组（73/699例（10.44%））相比，MPP组HF住院或全因死亡率的发生率较低[48/722例（6.64%）]，相对风险降低率（RRR）=36%（95%CI=±4%），P=0.0107。在多变量分析中，MPP与主要终点的发生率较低相关（比值比=0.60，P=0.0124）。在逻辑回归分析中，在整个人群和许多患者亚组中，如缺血性患者和心室电延迟长（>105 ms）的患者，MPP组的HF住院或全因死亡低于BIVP组。
在MORE-CRT MPP随机试验中，MPP与传统双心室起搏先前的无反应者的全因死亡率和HF住院率显著降低相关。
