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Kronborg MB, Frausing MHJP, Svendsen JH, Johansen JB, Riahi S, Haarbo J, Poulsen SH, Eiskjær H, Køber L, Øvrehus K, Sommer AM, Schou M, Nørgaard BL, Risum N, Poulsen MK, Søgaard P, Sandgaard N, Kofoed KF, Hansen TF, Graff C, Pedersen SS, Skals RG, Nielsen JC. Does targeted positioning of the left ventricular pacing lead towards the latest local electrical activation in cardiac resynchronization therapy reduce the incidence of death or hospitalization for heart failure? Am Heart J 2023; 263:112-122. [PMID: 37220821 DOI: 10.1016/j.ahj.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves symptoms, health-related quality of life and long-term survival in patients with systolic heart failure (HF) and shortens QRS duration. However, up to one third of patients attain no measurable clinical benefit from CRT. An important determinant of clinical response is optimal choice in left ventricular (LV) pacing site. Observational data have shown that achieving an LV lead position at a site of late electrical activation is associated with better clinical and echocardiographic outcomes compared to standard placement, but mapping-guided LV lead placement towards the site of latest electrical activation has never been investigated in a randomized controlled trial (RCT). The purpose of this study was to evaluate the effect of targeted positioning of the LV lead towards the latest electrically activated area. We hypothesize that this strategy is superior to standard LV lead placement. METHODS The DANISH-CRT trial is a national, double-blinded RCT (ClinicalTrials.gov NCT03280862). A total of 1,000 patients referred for a de novo CRT implantation or an upgrade to CRT from right ventricular pacing will be randomized 1:1 to receive conventional LV lead positioning preferably in a nonapical posterolateral branch of the coronary sinus (CS) (control group) or targeted positioning of the LV lead to the CS branch with the latest local electrical LV activation (intervention group). In the intervention group, late activation will be determined using electrical mapping of the CS. The primary endpoint is a composite of death and nonplanned HF hospitalization. Patients are followed for a minimum of 2 years and until 264 primary endpoints occurred. Analyses will be conducted according to the intention-to-treat principle. Enrollment for this trial began in March 2018, and per April 2023, a total of 823 patients have been included. Enrollment is expected to be complete by mid-2024. CONCLUSIONS The DANISH-CRT trial will clarify whether mapping-guided positioning of the LV lead according to the latest local electrical activation in the CS is beneficial for patients in terms of reducing the composite endpoint of death or nonplanned hospitalization for heart failure. Results from this trial are expected to impact future guidelines on CRT. CLINICALTRIALS GOV IDENTIFIER NCT03280862.
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Affiliation(s)
- Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Maria Hee Jung Park Frausing
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Haarbo
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kristian Øvrehus
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Risum
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Sandgaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Fritz Hansen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Susanne S Pedersen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Fairbairn TA, Nieman K, Akasaka T, Nørgaard BL, Berman DS, Raff G, Hurwitz-Koweek LM, Pontone G, Kawasaki T, Sand NP, Jensen JM, Amano T, Poon M, Øvrehus K, Sonck J, Rabbat M, Mullen S, De Bruyne B, Rogers C, Matsuo H, Bax JJ, Leipsic J, Patel MR. Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry. Eur Heart J 2018; 39:3701-3711. [PMID: 30165613 PMCID: PMC6215963 DOI: 10.1093/eurheartj/ehy530] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/09/2018] [Indexed: 11/18/2022] Open
Abstract
AIMS Non-invasive assessment of stable chest pain patients is a critical determinant of resource utilization and clinical outcomes. Increasingly coronary computed tomography angiography (CCTA) with selective CCTA-derived fractional flow reserve (FFRCT) is being used. The ADVANCE Registry, is a large prospective examination of using a CCTA and FFRCT diagnostic pathway in real-world settings, with the aim of determining the impact of this pathway on decision-making, downstream invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular events (MACE). METHODS AND RESULTS A total of 5083 patients with symptoms concerning for coronary artery disease (CAD) and atherosclerosis on CCTA were enrolled at 38 international sites from 15 July 2015 to 20 October 2017. Demographics, symptom status, CCTA and FFRCT findings, treatment plans, and 90 days outcomes were recorded. The primary endpoint of reclassification between core lab CCTA alone and CCTA plus FFRCT-based management plans occurred in 66.9% [confidence interval (CI): 64.8-67.6] of patients. Non-obstructive coronary disease was significantly lower in ICA patients with FFRCT ≤0.80 (14.4%) compared to patients with FFRCT >0.80 (43.8%, odds ratio 0.19, CI: 0.15-0.25, P < 0.001). In total, 72.3% of subjects undergoing ICA with FFRCT ≤0.80 were revascularized. No death/myocardial infarction (MI) occurred within 90 days in patients with FFRCT >0.80 (n = 1529), whereas 19 (0.6%) MACE [hazard ratio (HR) 19.75, CI: 1.19-326, P = 0.0008] and 14 (0.3%) death/MI (HR 14.68, CI 0.88-246, P = 0.039) occurred in subjects with an FFRCT ≤0.80. CONCLUSIONS In a large international multicentre population, FFRCT modified treatment recommendation in two-thirds of subjects as compared to CCTA alone, was associated with less negative ICA, predicted revascularization, and identified subjects at low risk of adverse events through 90 days.
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Affiliation(s)
| | - Koen Nieman
- Stanford and Erasmus Medical Center, Rotterdam, Netherlands
| | - Takashi Akasaka
- Wakayama Medical University, 811-1 Kimiidera Wakayama, Wakayama, Japan
| | - Bjarne L Nørgaard
- Aarhus University Hospital, Department Cardiology B, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Daniel S Berman
- Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - Gilbert Raff
- William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI, USA
| | | | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, University of Milan, Via Carlo Parea 4, Milan, Italy
| | | | - Niels Peter Sand
- University of Southern Denmark, Sdr Boulevard 29, Odense, Denmark
| | - Jesper M Jensen
- Aarhus University Hospital, Department Cardiology B, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Tetsuya Amano
- Aichi Medical University, 1-1 Yazakokarimata Nagakute, Aichi, Japan
| | - Michael Poon
- Northwell Health, 100 E 77th Street, New York, NY, USA
| | - Kristian Øvrehus
- University of Southern Denmark, Sdr Boulevard 29, Odense, Denmark
| | - Jeroen Sonck
- UZ Brussels, Laarbeeklaan 101, Brussels, Belgium
| | - Mark Rabbat
- Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, USA
| | - Sarah Mullen
- HeartFlow Inc., 1400 Seaport Blvd, Bldg B, Redwood City, CA, USA
| | | | - Campbell Rogers
- HeartFlow Inc., 1400 Seaport Blvd, Bldg B, Redwood City, CA, USA
| | - Hitoshi Matsuo
- Gifu Heart Center, 4-14-4 Yabutaminami, Gifu Gifu, Japan
| | - Jeroen J Bax
- Leiden University Medical Center, Albinusdreef 2, Leiden, AZ, Netherlands
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada
| | - Manesh R Patel
- Duke University School of Medicine, 2301 Erwin Road, Durham, NC, USA
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Jensen JK, Øvrehus K, Møldrup M, Mickley H, Høilund-Carlsen PF. Redefinition of the Q wave -- is there a clinical problem? Am J Cardiol 2006; 97:974-6. [PMID: 16563898 DOI: 10.1016/j.amjcard.2005.10.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 10/07/2005] [Accepted: 10/07/2005] [Indexed: 11/29/2022]
Abstract
This study evaluated the potential consequences of the redefined joint European/American electrocardiographic criteria for an established myocardial infarction (MI). New and previous diagnostic Q-wave criteria were used in patients with stable angina pectoris. Seventy-nine patients with and 77 patients without a documented previous MI were compared using the results of myocardial perfusion imaging at rest as a reference. With the new Q-wave criteria, 71% of the former group and 40% of the latter had evidence of established MI compared with 33% and 3% when using the previous criteria (p <0.0001). Sensitivity, specificity, and positive and negative predictive values were 71%, 60%, 64%, and 67% for the new criteria versus 33%, 97%, 93%, and 59% with the previous criteria. These data suggest that that the new Q-wave criteria may be too nonspecific, resulting in an inappropriately high number of false-positive results.
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Affiliation(s)
- Jesper K Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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