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SPECT GUIDED LV LEAD PLACEMENT FOR INCREMENTAL BENEFITS TO CRT EFFICACY: A PROSPECTIVE MULTICENTER RANDOMIZED CONTROLLED TRIAL
694 JACC March 21, 2017 Volume 69, Issue 11
Heart Failure and Cardiomyopathies SPECT GUIDED LV LEAD PLACEMENT FOR INCREMENTAL BENEFITS TO CRT EFFICACY: A PROSPECTIVE MULTICENTER RANDOMIZED CONTROLLED TRIAL Moderated Poster Contributions Heart Failure and Cardiomyopathies Moderated Poster Theater, Poster Hall, Hall C Sunday, March 19, 2017, 10:00 a.m.-10:10 a.m. Session Title: Leading Us Astray? Pacemakers in Cardiomyopathies Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy Presentation Number: 1308M-05 Authors: Jiangang Zou, Xiaofeng Hou, Ji Chen, Kejiang Cao, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
Background: Left ventricular (LV) lead placement at viable regions with latest mechanical activation is related with enhanced response to cardiac resynchronization therapy (CRT) in chronic heart failure (CHF) patients. We conducted a prospective multicenter randomized controlled trial to compare CRT response between patients undergoing either SPECT-guided or standard-of-care LV lead placement.
Methods: A total of 177 CHF patients (age 65 ± 8 yrs, EF 26.8 ± 5.4%, QRS 148.7 ± 27.5 ms) indicated for CRT implantation were enrolled and underwent SPECT myocardial perfusion imaging at baseline to assess LV dyssynchrony, the latest activation site, and the region of scar tissue. Patients were subsequently randomized to stand-of-care implantation (control group) and SPECT-guided LV lead placement (guided group). SPECT phase analysis was used to automatically divide the LV into 13 segments and then identify the segments with viable myocardium >50% and largest mean phase as the optimal LV lead location. In the guided group, the implanters received the SPECT image guides and tried to place the LV leads into the optimal segments or the nearby segments if there were no suitable veins. The actual LV lead positions in both groups were documented using post-implant CT scans. The primary endpoint was change in LVESV at 6 months post implantation. The secondary endpoints included changes in LVEDV and EF.
Results: There were no differences in baseline characteristics between the two groups. CRT significantly reduced LVESV/LVEDV and increased LVEF in two groups. The reductions in LVESV and LVEDV in the guided group were significantly greater than those in the control group (50.0 ml vs 28.7 ml, P=0.019 and 56.6 ml vs 30.6 ml, P=0.048), respectively. LVEF increased from 27.2% to 35.9% (P<0.01) in the control group and 26.5% to 37.9% (P<0.01) in the guided group, without statistically significance between the two groups. Conclusions: Guiding LV lead placement to the latest activation site and away from scar tissue using SPECT myocardial perfusion imaging phase analysis is associated with a better response to CRT as compared to the standard-of-care LV lead placement.
Heart Failure and Cardiomyopathies SPECT GUIDED LV LEAD PLACEMENT FOR INCREMENTAL BENEFITS TO CRT EFFICACY: A PROSPECTIVE MULTICENTER RANDOMIZED CONTROLLED TRIAL Moderated Poster Contributions Heart Failure and Cardiomyopathies Moderated Poster Theater, Poster Hall, Hall C Sunday, March 19, 2017, 10:00 a.m.-10:10 a.m. Session Title: Leading Us Astray? Pacemakers in Cardiomyopathies Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy Presentation Number: 1308M-05 Authors: Jiangang Zou, Xiaofeng Hou, Ji Chen, Kejiang Cao, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
Background: Left ventricular (LV) lead placement at viable regions with latest mechanical activation is related with enhanced response to cardiac resynchronization therapy (CRT) in chronic heart failure (CHF) patients. We conducted a prospective multicenter randomized controlled trial to compare CRT response between patients undergoing either SPECT-guided or standard-of-care LV lead placement.
Methods: A total of 177 CHF patients (age 65 ± 8 yrs, EF 26.8 ± 5.4%, QRS 148.7 ± 27.5 ms) indicated for CRT implantation were enrolled and underwent SPECT myocardial perfusion imaging at baseline to assess LV dyssynchrony, the latest activation site, and the region of scar tissue. Patients were subsequently randomized to stand-of-care implantation (control group) and SPECT-guided LV lead placement (guided group). SPECT phase analysis was used to automatically divide the LV into 13 segments and then identify the segments with viable myocardium >50% and largest mean phase as the optimal LV lead location. In the guided group, the implanters received the SPECT image guides and tried to place the LV leads into the optimal segments or the nearby segments if there were no suitable veins. The actual LV lead positions in both groups were documented using post-implant CT scans. The primary endpoint was change in LVESV at 6 months post implantation. The secondary endpoints included changes in LVEDV and EF.
Results: There were no differences in baseline characteristics between the two groups. CRT significantly reduced LVESV/LVEDV and increased LVEF in two groups. The reductions in LVESV and LVEDV in the guided group were significantly greater than those in the control group (50.0 ml vs 28.7 ml, P=0.019 and 56.6 ml vs 30.6 ml, P=0.048), respectively. LVEF increased from 27.2% to 35.9% (P<0.01) in the control group and 26.5% to 37.9% (P<0.01) in the guided group, without statistically significance between the two groups. Conclusions: Guiding LV lead placement to the latest activation site and away from scar tissue using SPECT myocardial perfusion imaging phase analysis is associated with a better response to CRT as compared to the standard-of-care LV lead placement.