心脏再同步化治疗
医学
心脏病学
射血分数
内科学
心力衰竭
临床终点
心室重构
随机对照试验
作者
Michael R. Gold,Kenneth A. Ellenbogen,Christophe Leclercq,Jonathan Lowy,Seth J. Rials,Morio Shoda,Gery Tomassoni,Ziad F. Issa,J. Sarrazin,John Jennings,Devi G. Nair,Nicholas Wold,Patrick Yong,Michelle M. Harbin,Kenneth M. Steín,Angelo Auricchio
出处
期刊:Circulation-arrhythmia and Electrophysiology
[Ovid Technologies (Wolters Kluwer)]
日期:2023-06-01
卷期号:16 (6)
被引量:8
标识
DOI:10.1161/circep.122.011714
摘要
Background: The role of atrioventricular optimization (AVO) to improve cardiac resynchronization therapy outcomes remains controversial. Previous post hoc analyses of a multicenter trial showed that measures of electrical dyssynchrony (right ventricular–left ventricular [LV] or LV electrical delay durations) are associated with patients who benefit from AVO. Methods: This was a global, multicenter, prospective, randomized trial of de novo cardiac resynchronization therapy implant patients with an right ventricular–LV duration ≥70 ms to determine whether AVO results in greater reverse remodeling. Patients were randomized 1:1 for either an AVO algorithm (SmartDelay) that determines atrioventricular delay and pacing chamber, biventricular or LV only, or a fixed atrioventricular delay of 120 ms with biventricular pacing. Paired echocardiograms performed at baseline and 6 months were evaluated. The primary end point was echocardiographic cardiac resynchronization therapy response, defined dichotomously as a >15% reduction in LV end-systolic volume. Results: A total of 310 patients (n=120 women) were randomized and had completed 6 months of follow-up. The echocardiographic cardiac resynchronization therapy response rate did not statistically differ between the groups (SmartDelay, 74.8%; fixed, 67.7%; P =0.17). Analyses of prespecified secondary end points demonstrated significant improvements in the absolute (median: SmartDelay, −41.0 mL; fixed, −33.0 mL; P =0.01) and relative change in LV end-systolic volume (SmartDelay, −38.3%; fixed, −27.8%; P =0.03) for patients with SmartDelay optimization. Similar results were observed for the relative improvement in LV ejection fraction (SmartDelay, 46.7%; fixed, 32.1%; P =0.050); absolute improvement in LV ejection fraction trended to be higher with SmartDelay ( P =0.06). Conclusions: Analysis of reverse remodeling parameters demonstrated that AVO via SmartDelay, relative to the nonoptimized fixed atrioventricular delay comparator group, improved absolute and relative changes in LV function in patients with longer right ventricular–LV duration. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03089281.
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