Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy The TARGET Study: A Randomized, Controlled Trial
Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy The TARGET Study: A Randomized, Controlled Trial
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DOI：
10.1016/j.jacc.2011.12.030
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发表时间：
2012-04-24
影响因子：
24
通讯作者：
Dutka, David P.
中科院分区：
文献类型：
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作者：
Khan, Fakhar Z.;Virdee, Mumohan S.;Dutka, David P.
目的本研究旨在评估靶向左心室（LV）电极导线放置对心脏起搏治疗（CRT）结局的影响。背景将LV电极导线放置在最新收缩部位并远离瘢痕可获得CRT的最佳反应。我们进行了一项随机对照试验，比较有针对性的方法，以LV铅放置与常规care.Methods共220例患者预定CRT进行基线超声心动图斑点追踪二维径向应变成像，然后随机1：1分为2组。在第1组（靶向左心室电极导线放置以指导心脏复苏治疗）中，LV电极导线定位在最新的峰值收缩部位，振幅>10%，表示无瘢痕。第2组（对照组）患者接受标准非引导CRT。根据LV电极导线与最佳部位的关系将患者分类为一致（在最佳部位）、相邻（1个节段内）或远端（>2个节段）。主要终点是6个月时左心室收缩末期容积减少≥ 15%。次要终点为临床反应（纽约心脏协会心功能分级改善>= 1）、全因死亡率、全因死亡率和心力衰竭相关住院率。在TARGET组中，6个月时应答者的比例更高（70% vs. 55%，p = 0.031），主要终点的绝对差异为15%（95%置信区间：2%-28%）。与对照组相比，TARGET患者的临床反应更高（83% vs. 65%，p = 0.003）和联合终点发生率较低（log-rank检验，p = 0.031）结论与标准CRT治疗相比，使用speckle-跟踪超声心动图到目标LV电极导线放置可显著改善反应和临床状态，降低死亡和心脏病合并发生率。失败相关的住院治疗。（靶向左心室电极导线放置以指导心脏复苏治疗[TARGET]研究）; ISRCTN 19717943）（J Am科尔心脏病学杂志2012;59：1509-18）（C）2012年美国心脏病学会基金会
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) (J Am Coll Cardiol 2012;59:1509-18) (C) 2012 by the American College of Cardiology Foundation