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Observational Study
. 2020 Mar;21(3):250-258.
doi: 10.2459/JCM.0000000000000928.

Design and rationale of the Impact of MultiPoint pacing in CRT patients with reduced RV-to-LV delay (IMAGE-CRT) study

Francesco Solimene  1 , Gerardo Nigro  2 , Michelangelo Canciello  3 , Vincenzo Tavoletta  4 , Gergana Shopova  1 , Raimondo Calvanese  3 , Anna Rago  2 , Concetto La Rosa  5 , Felice Nappi  6 , Miguel Viscusi  7 , Francesco Urraro  8 , Gianluca Manzo  9 , Paolo Gallo  10 , Andrea Andriani  11 , Giovanni Rovaris  12 , Pietro Palmisano  13 , Sara Innocenti  14 , Antonio D'Onofrio  4
Affiliations
Observational Study

Design and rationale of the Impact of MultiPoint pacing in CRT patients with reduced RV-to-LV delay (IMAGE-CRT) study

Francesco Solimene et al. J Cardiovasc Med (Hagerstown). 2020 Mar.

Abstract

Background: Cardiac resynchronization therapy (CRT) is an established treatment in patients with heart failure and prolonged QRS duration. A biventricular device is implanted to achieve faster activation and more synchronous contraction of the ventricles. Despite the convincing effect of CRT, 30-40% of patients do not respond. We decided to investigate the role of multipoint pacing (MPP) in a selected group of patients with right ventricle (RV)-to-left ventricle (LV) intervals less than 80 ms that do not respond to traditional CRT.

Methods: We will enrol 248 patients in this patient-blinded, observational, clinical study aiming to investigate if MPP could decrease LV end-systolic volume (ESV) in patients with RV-to-LV interval less than 80 ms. MPP will be activated ON at implant in patients with RV-to-LV delay less than 80 ms and OFF in RV-to-LV at least 80 ms. At follow-up the activation of MPP will be related to CRT response. The primary study endpoint will be the responder rate at 6 months, defined as a decrease in LV ejection fraction, LV end-diastolic volume, LV end-systolic volume (LVESV) at least 15% from baseline. Secondary outcomes include 12 months relative percentage reduction in LVESV and a combined clinical outcome measure of response to CRT defined as the patient being alive, no hospitalization due to heart failure, and experiencing an improvement in New York Heart Association functional class (Composite-Score).

Conclusion: Reducing the nonresponder rate continues to be an important goal for CRT.If an increase in reverse remodelling can be achieved by MPP, this study supports the conduct of larger trials investigating the role of MPP on clinical outcomes in selected patients treated, right now, only with traditional CRT.

Trial registration: ClinicalTrials.gov, NCT02713308. Registered on 18 March 2016.

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References

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