Targeted left ventricular lead placement improved the rate of ≥15% reduction in LV end-systolic volume at 6 months compared with standard CRT (70% vs 55%; P=0.031).
RCT (n=220)
1:1
Does targeted LV lead placement guided by speckle-tracking echocardiography improve echocardiographic response in patients scheduled for CRT?
Targeted LV lead placement using speckle-tracking echocardiography significantly improves echocardiographic response, clinical status, and clinical outcomes compared to standard unguided CRT.
Absolute Risk Reduction: 15 (95% CI 2–28)
Absolute Event Rate: 70% vs 55%
Absolute Risk Reduction: 15%
p-value: p=0.031
OBJECTIVES: This study sought to assess the impact of targeted left ventricular (LV) lead placement on outcomes of cardiac resynchronization therapy (CRT). BACKGROUND: Placement of the LV lead to the latest sites of contraction and away from the scar confers the best response to CRT. We conducted a randomized, controlled trial to compare a targeted approach to LV lead placement with usual care. METHODS: A total of 220 patients scheduled for CRT underwent baseline echocardiographic speckle-tracking 2-dimensional radial strain imaging and were then randomized 1:1 into 2 groups. In group 1 (TARGET Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy), the LV lead was positioned at the latest site of peak contraction with an amplitude of >10% to signify freedom from scar. In group 2 (control) patients underwent standard unguided CRT. Patients were classified by the relationship of the LV lead to the optimal site as concordant (at optimal site), adjacent (within 1 segment), or remote (≥2 segments away). The primary endpoint was a ≥15% reduction in LV end-systolic volume at 6 months. Secondary endpoints were clinical response (≥1 improvement in New York Heart Association functional class), all-cause mortality, and combined all-cause mortality and heart failure-related hospitalization. RESULTS: The groups were balanced at randomization. In the TARGET group, there was a greater proportion of responders at 6 months (70% vs. 55%, p = 0.031), giving an absolute difference in the primary endpoint of 15% (95% confidence interval: 2% to 28%). Compared with controls, TARGET patients had a higher clinical response (83% vs. 65%, p = 0.003) and lower rates of the combined endpoint (log-rank test, p = 0.031). CONCLUSIONS: Compared with standard CRT treatment, the use of speckle-tracking echocardiography to the target LV lead placement yields significantly improved response and clinical status and lower rates of combined death and heart failure-related hospitalization. (Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy TARGET study); ISRCTN19717943).
Khan et al. (Thu,) conducted a rct in Heart failure requiring cardiac resynchronization therapy (n=220). Targeted left ventricular lead placement using speckle-tracking echocardiography vs. Standard unguided CRT was evaluated on ≥15% reduction in LV end-systolic volume at 6 months (absolute difference 15%, 95% CI 2 to 28, p=0.031). Targeted left ventricular lead placement improved the rate of ≥15% reduction in LV end-systolic volume at 6 months compared with standard CRT (70% vs 55%; P=0.031).