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Image-guided left ventricular lead placement in cardiac resynchronization therapy for patients with heart failure: a
Yan Jin1, Qi Zhang2, Jia-Liang Mao2
1Department of Cardiology, Ren Ji hospital, School of Medicine, Shanghai Jiao Tong University, 200001, Shanghai, China. jessijin@msn.com.
Insights
Image-guided cardiac resynchronization therapy (CRT) significantly improves treatment response and heart function compared to standard CRT. This approach enhances left ventricular ejection fraction and reduces end-systolic volume, offering better clinical outcomes for heart failure patients.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Trials
Background:
- Heart failure (HF) is a widespread and debilitating condition.
- Cardiac resynchronization therapy (CRT) is a key treatment for HF.
- Echocardiography (ECHO) is increasingly used to optimize left ventricular (LV) lead placement in CRT.
Purpose of the Study:
- To compare the efficacy of image-guided CRT versus standard CRT.
- To synthesize data on CRT optimization using echocardiography.
Main Methods:
- Systematic literature search of PubMed, Cochrane, Embase, and ISI Web of Knowledge databases through April 2014.
- Inclusion of studies on left ventricular lead placement, CRT, and image-guided or echocardiography-guided techniques.
- Primary outcomes: CRT response rate, LV ejection fraction (LVEF) change, LV end systolic volume (LVESV) change.
Main Results:
- Analysis of 3 randomized trials with 270 patients in image-guided CRT and 241 in standard CRT.
- Image-guided CRT showed significantly higher CRT response rates (OR, 2.098).
- Significant improvements in LVEF (difference in means, 3.457) and reduction in LVESV (difference in means, -20.36) with image-guided CRT.
Conclusions:
- Image-guided CRT demonstrates superior clinical outcomes compared to standard CRT.
- The use of imaging for prospective CRT optimization requires further validation through additional trials.
Background:
Heart failure (HF) is a debilitating condition that affects millions of people worldwide. One means of treating HF is cardiac resynchronization therapy (CRT). Recently, several studies have examined the use of echocardiography (ECHO) in the optimization of left ventricular (LV) lead placement to increase the response to CRT. The objective of this study was to synthesize the available data on the comparative efficacy of image-guided and standard CRT.
Methods:
We searched the PubMed, Cochrane, Embase, and ISI Web of Knowledge databases through April 2014 with the following combinations of search terms: left ventricular lead placement, cardiac resynchronization therapy, image-guided, and echocardiography-guided. Studies meeting all of the inclusion criteria and none of the exclusion criteria were eligible for inclusion. The primary outcome measures were CRT response rate, change in LV ejection fraction (LVEF), and change in LV end systolic volume (LVESV). Secondary outcomes included the rates of all-cause mortality and HF-related hospitalization.
Results:
Our search identified 103 articles, 3 of which were included in the analysis. In total, 270 patients were randomized to the image-guided CRT and 241, to the standard CRT. The pooled estimates showed a significant benefit for image-guided CRT (CRT response: OR, 2.098, 95 % CI, 1.432-3.072; LVEF: difference in means, 3.457, 95 % CI, 1.910-5.005; LVESV: difference in means, -20.36, 95 % CI, -27.819 - -12.902).
Conclusions:
Image-guided CRT produced significantly better clinical outcomes than the standard CRT. Additional trials are warranted to validate the use of imaging in the prospective optimization of CRT.
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