The role of multipoint left ventricular pacing compared to optimized cardiac resynchronization therapy on long-term follow-up in chronic heart failure patients

Abstract Objectives The aim of this study was to assess the capacity of optimized multipoint pacing (MPP) over cardiac resynchronization therapy (CRT), in terms of clinical, functional, and echocardiographic parameters among dyssynchronous heart failure (HF) patients on the 5-year mortality. Methods We evaluated the echocardiographic and clinical response of 80 patients (Caucasian, 77. 5% male, 68. 4±10. 1 years, 53. 8% ischemic cardiomyopathy) with HF under optimal medical treatment, treated with either CRT with hemodynamic and electrical optimization of the LV pacing site (optimized OPT-CRT n= 34, 49%), or OPT combined with MPP (OPT-MPP group, n =36, 51%) for a follow-up of 5 -years. Responders were classified in terms of reduction in end-systolic volume index ≥15% and reduction in New York Heart Association (NYHA) class ≥1. Clinical, laboratory and echocardiographic assessment was conducted at baseline and at 6 and 12 months of follow-up. Ventricle-arterial coupling (VAC) and Minesota Quality of Life Questionnaire was also calculated in each visit. Results During the 5-year follow-up, 36 patients died (45 per 100 patients mortality rate). There was a significant difference in death rates between OPT (54%) and OPT-MPP (40%), revealing that MPP-OPT was related with 7% less probability of death in a 5-year follow-up, compared with CRTOPT (p=0. 01). The diseased patients had higher prevalence of ischemic HF, impaired baseline VAC, higher baseline left atrial (LA) volume, impaired baseline LA strain and lower baseline right ventricle (RV) strain (all p-values0. 05). Furthermore, MPP-OPT had higher survival rates, through beneficial effect on VAC (OR=0. 03, 95%CI 0. 02-0. 467) and LA strain (OR=0. 68, 95% CI 0. 507-0. 929), reflected on better score on Minnesota QoL questionnaire (OR=0. 89, 95%CI 0. 799-0. 99), compared to CRT-OPT. Those long-term follow-up results probably reflect the differences observed between OPTCRT and OPTMPP at the first year of follow-up; where OPT MPP showed better 6-minute walking distance (405±129m vs 367±94m vs. p0. 001), NYHA class (2. 36 vs. . 45, p0. 001), VTIlvot (17. 5±3. 4 vs 14. 25±3. 2cm, p0. 001), stroke volume (59±15ml vs 48±13. 5ml, p0. 001), LVEF (37%±7. 7% vs. 29%±7. 1% p0. 001), LA volume (67. 7±32 vs. 77. 2±34. 2ml, p=0. 02), RV strain (-11. 8%±6. 1% vs. 8. 3%±6. 9%, p=0. 022). Conclusions In chronic heart failure patients under CRT implantation, optimization of MPP showed beneficial effect on survival especially compared to optimization of CRT only, through favorable changes in various clinical, functional, and echocardiographic parameters, as well as quality of life. Combining MPP with optimization, both electrical and hemodynamic, was found to be able to reverse the long-term progression of HF and to improve clinical outcomes,