Key result
Multipoint cardiac resynchronization therapy significantly improved functional class compared to conventional therapy in 139 heart failure patients, though echocardiographic differences were not significant.
Why the study?
Response rates to conventional cardiac resynchronization therapy are approximately 50%, prompting evaluation of multipoint cardiac resynchronization therapy.
Does multipoint cardiac resynchronization therapy improve clinical and echocardiographic outcomes compared to conventional therapy in patients with heart failure?
Systematic Review (n=139)
Does multipoint cardiac resynchronization therapy improve clinical and echocardiographic outcomes compared to conventional therapy in patients with heart failure?
Multipoint cardiac resynchronization therapy may offer slight improvements in functional class over conventional CRT, but current evidence from RCTs is insufficient to draw robust conclusions.
Answers are grounded in this paper and cite their sources.
May modestly improve functional class in HF; leaves open echocardiographic superiority of multipoint over conventional CRT.
BACKGROUND: Cardiac resynchronization therapy is an important validated technique for patients with dyssynchrony and heart failure. However, the response rate to conventional resynchronization is approximately 50%; therefore, new techniques and schedules have emerged. This study aimed to evaluate the different clinical and echocardiographic variables of conventional versus multipoint cardiac resynchronization therapy. RESEARCH DESIGN AND METHOD: A systematic review was conducted of randomized clinical trials in the PubMed, Cochrane, and Embase databases on cardiac resynchronization intervention with multipoint stimulation clinical and echocardiographic outcomes evaluated before and 3 months after the intervention. RESULTS: Three studies (N = 139) were ultimately selected, and 100% of patients had a New York Heart Association functional class of II-IV, QRS > 120 ms, and a left ventricular ejection fraction < 35%. Significantly greater improvement was observed in the functional class of patients who underwent multipoint versus conventional therapy. The final systolic volume and ejection fraction improved in the multipoint group, but the difference was not statistically significant. CONCLUSIONS: The literature lacks sufficient randomized controlled studies to enable conclusions regarding cardiac resynchronization therapy responses using different strategies. Moreover, the improvement in functional class in the multipoint pacing group involved few patients and had slight statistical relevance.
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Bessa et al. (2021) conducted a systematic review in heart failure (n=139). multipoint cardiac resynchronization therapy vs. conventional cardiac resynchronization therapy was evaluated on clinical and echocardiographic outcomes (functional class, final systolic volume, and ejection fraction). Multipoint cardiac resynchronization therapy significantly improved functional class compared to conventional therapy in 139 heart failure patients, though echocardiographic differences were not significant.
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