Evaluation of Short-Term Pacing Effect to Predict Long-Term Response to Cardiac Resynchronization Therapy: the TRAJECTORIES Study

G. Santarelli, Roberta Ciccotelli, G. Molon, F. Zanon, A. Corzani, A. Rossillo, M. Biffi, G. Zanotto, L. Lanzoni, S. Severi, C. Tomasi, C. Corsi
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Abstract

Cardiac resynchronization therapy (CRT) is an effective treatment for chronic symptomatic systolic heart failure with cardiac dyssynchrony, but about 1/3 of patients do not respond favorably to the therapy. We hypothesized that acute modifications of the coronary sinus (CS) pacing cathode movements induced by biventricular pacing may be related to resynchronization process and consequently may carry predictive power on CRT response. A method for the 3D reconstruction of CS lead’s pacing cathode trajectory (3DTJ) throughout a cardiac cycle showed that trajectory’s geometry suddenly changed in responders (R) upon starting of biventricular pacing, becoming less eccentric and more multi-directional. Our multicenter observational study aimed at evaluating the clinical value of 3DTJ. Out of 119 patients enrolled, 50 have ended follow-up and have been analyzed. Concordance between 3DTJ metrics and response was 82% overall (41/50), 91% in R (31/34), 62% in NR (10/16). The proposed 3DTJ metric showed high sensitivity (91%) with specificity=62%; PPV=84%, NPV=77%. From our data, 3DTJ seems a promising tool to acutely predict CS pacing site-specific response to CRT. Its investigational use as an intra-operatory, real-time guidance for selecting LV pacing sites may open new opportunities for CRT patients’ selection and therapy delivery.
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评估短期起搏效果以预测心脏再同步化治疗的长期反应:轨迹研究
心脏再同步化治疗(CRT)是治疗伴有心脏非同步化的慢性症状性收缩期心力衰竭的有效方法,但约1/3的患者对该治疗反应不良。我们假设双心室起搏引起的冠状窦起搏阴极运动的急性改变可能与再同步过程有关,因此可能对CRT反应具有预测作用。一种心脏周期内CS导联起搏阴极轨迹(3DTJ)的三维重建方法显示,在双心室起搏开始后,响应者(R)的轨迹几何形状突然发生变化,变得不那么偏心,更加多向。我们的多中心观察研究旨在评估3DTJ的临床价值。在纳入的119例患者中,有50例已结束随访并进行了分析。3DTJ指标与反应的一致性总体为82% (41/50),R为91% (31/34),NR为62%(10/16)。提出的3DTJ指标灵敏度高(91%),特异度为62%;PPV = 84%,净现值= 77%。从我们的数据来看,3DTJ似乎是一个很有前途的工具,可以准确预测CS起搏部位对CRT的特异性反应。它作为术中实时指导左室起搏点选择的研究应用,可能为CRT患者的选择和治疗提供新的机会。
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