Cardiac Resynchronization Therapy Guided by Echocardiography, MRI, and CT Imaging: A Randomized Controlled Study

OBJECTIVES This study evaluated if selecting the left ventricular (LV) target segment by echocardiography-derived late mechanical activation, with access to multimodatity imaging for scar and venous anatomy, could help to increase responder rates to cardiac resynchronization therapy (CRT).BACKGROUND LV lead placement is important for clinical outcome, but the optimal strategy for LV lead placement in CRT is still debated.METHODS This study conducted a prospective, blinded randomized controlled trial on 102 patients with indication for CRT (27% women, 46% with ischemic cardiomyopathy, 63% in New York Heart Association functional class III, 74% with left bundle branch block, and with mean ejection fraction of 23%). Optimal LV lead location was defined as the latest mechanically activated available segment (free of transmurat scar), determined by radial strain echocardiography, cardiac computed tomography, and cardiac magnetic resonance (n=70). The primary endpoint was reduction of LV end-systolic volume by >= 15% at 6 months post-implantation.RESULTS Patients were followed for 47 +/- 21 months. Based on imaging, optimal or adjacent lead placement was feasible in 96% of all cases and was obtained in 83% of the intervention group versus 80% of the control group. Fifty-six percent of the patients were LV end-systolic volume responders compared with the control group (55%) (p = 0.96), and 71% improved >= 1 New York Heart Association functional class (74% vs. 67%; p = 0.43). Death or heart failure hospitalization within 2 years occurred in 6% (2% of the intervention group vs. 10% of the control group; p = 0.07).CONCLUSIONS Radial strain-guided LV lead placement, in combination with multimodatity imaging, did not result in increased clinical or echocardiographic response, nor in a significant reduction of death or heart failure hospitalization. (C) 2020 by the American College of Cardiology Foundation.