Τίτλος:
Multipoint left ventricular pacing effects on hemodynamic parameters and
functional status: HUMVEE single-arm clinical trial (NCT03189368)
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objectives: 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).
Methods: 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.
Results: 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), VTIlvot
(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.
Conclusions: 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. (c) 2021 Hellenic Society of Cardiology.
Publishing services by Elsevier B.V. This is an open access article
under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Συγγραφείς:
Antoniou, Christos-Konstantinos
Dilaveris, Polychronis and
Chrysohoou, Christina
Konstantinou, Konstantinos
Magkas,
Nikolaos
Xydis, Panagiotis
Manolakou, Panagiota
Skiadas,
Ioannis
Gatzoulis, Konstantinos A.
Tousoulis, Dimitris and
Tsioufis, Costas
Περιοδικό:
Ελληνική καρδιολογική επιθεώρηση
Εκδότης:
HELLENIC CARDIOLOGICAL SOC
Λέξεις-κλειδιά:
Dyssynchronous heart failure; Multipoint pacing; Optimized cardiac
resynchronization therapy; Ventriculoarterial coupling; Echocardiography
DOI:
10.1016/j.hjc.2021.02.012
