Daily Cardiology Research Analysis

BACKGROUND: To improve cardiac resynchronization therapy (CRT) an on-screen image-guidance platform, CARTBox-Suite (CART-Tech B.V.), was developed to identify left ventricular pacing electrode (LVPE) implantation sites and facilitate precise LVPE placement. This multicenter randomized trial evaluated the efficacy of image guidance on LVPE implantation accuracy and its impact on left ventricular end-systolic volume (LVESV) reduction 6 months after CRT. OBJECTIVES: The aim of this trial is to improve the accuracy and efficacy of LVPE placement in CRT. METHODS: A total of 131 heart failure patients (80% with Class I CRT indication) were enrolled across 7 hospitals in the Netherlands. CARTBox-Suite, which utilizes a cloud-based AI algorithm, was used to identify a target area with late mechanical activation based on cardiac magnetic resonance imaging. Scarred areas marked by late gadolinium enhancement were excluded. Patients were randomized to image-guided implantation, with on-screen guidance during the procedure or conventional implantation. RESULTS: The primary endpoint, LVPE implantation in the target area, was achieved significantly more often in the image-guided group (66.7% vs 29.2%; P < 0.001). The secondary endpoint was fewer LVPE placed in scarred areas in the image-guided group (7.1% vs 36.4%; P = 0.006). Mean LVESV reduction was greater in the image-guided group (43.2% vs. 37.6%), although not significantly (P = 0.166). Patients with myocardial scar showed greater LVESV reduction with image guidance (40.7% vs 27.7%; P = 0.028). CONCLUSIONS: Image-guided implantation resulted in significantly more LVPE placed in the target area and greater LVESV reduction in patients with myocardial scar.

BACKGROUND: Previous reports of longer-term outcomes of transcatheter aortic valve implantation (TAVI) focus on higher risk patients and suggest potential temporal changes. AIMS: To evaluate the longer-term and temporal performances of TAVI compared to surgical aortic valve replacement (SAVR). METHODS: Randomized controlled trials reporting outcomes with at least 1-year follow-up. The primary outcome was the composite of all-cause death or disabling stroke. RESULTS: We included 8 trials with 8,749 patients. TAVI was associated with a higher risk of longer-term (5-year) primary outcome compared to SAVR among higher-risk [odds ratio (OR), 1.25; 95% CI, 1.07-1.47] but not lower-risk participants [1.0 (0.77-1.29)]. However, a significant temporal interaction was detected in both risk profiles. TAVI with balloon-expandable valves was associated with a higher risk of longer-term primary outcome compared to SAVR [1.38 (1.2-1.6)], whereas no statistical difference was found with self-expanding valves [1.03 (0.89-1.19)]. There was a significant interaction between the two valve systems, and a temporal interaction was detected in both systems. Overall landmark analysis revealed a lower risk in TAVI within the initial 30 days [0.76 (0.6, 0.96)], comparable between 30 days to 2 years [1.04 (0.85, 1.28)], and higher beyond 2 years [1.36 (1.15-1.61)]. Analysis for all-cause death generated largely similar results. CONCLUSIONS: TAVI was associated with a higher longer-term risk of primary outcome compared to SAVR in higher-risk patients and with balloon-expandable valves. However, a characteristic temporal interaction was documented in all subgroups. Future studies are warranted to test these findings.

BACKGROUND: The lower limit of the reference normal range (LLN) of left ventricular global longitudinal strain (GLS) for each ultrasound software vendor and its prognostic relevance in the elderly and in asymptomatic patients at risk for heart failure (HF) remain uncertain. OBJECTIVES: In this study, the authors sought to validate the LLN of GLS for each ultrasound software vendor and its prognostic relevance in the elderly and in asymptomatic patients at risk for HF. METHODS: To identify the LLN of GLS with the use of 2-dimensional speckle-tracking transthoracic echocardiography, a meta-analysis of studies including healthy subjects was conducted, followed by a validation study in a large cohort of healthy subjects. To validate the prognostic relevance of the LLN of GLS, 2 validation cohort studies were carried out, including elderly subjects aged ≥80 years and asymptomatic ambulatory patients with preserved left ventricular ejection fraction at risk for HF. RESULTS: The meta-analysis, which included 47 studies with a total of 23,208 healthy adult subjects, identified the LLN for GLS at 16% (absolute value) across various ultrasound software vendors, including EchoPac, TomTec, and QLab. In the validation cohort study, which included 2,217 healthy adult subjects, a GLS cutoff of 16% was also identified as the LLN. Concerning the prognostic relevance of the LLN of GLS, a value of GLS <16% was significantly associated with HF hospitalization in asymptomatic ambulatory patients at risk for HF (n = 667; OR within 6 years: 5.1 [95% CI: 1.5-17.0]) and in elderly subjects (n = 159; OR within 2 years: 3.1 [95% CI: 1.1-8.8]). CONCLUSIONS: This clinical validation study provides important clinical data concerning the LLN of GLS (identified and validated at 16%) and its prognostic relevance in the elderly and in asymptomatic ambulatory patients at risk for HF.