Abstract 11933: Echoguided Lead Placement Benefits Patients with QRS Durations < 150 ms : Results from STARTER Randomized Controlled Trial
Background: Recent Heart Failure Society of America guidelines have questioned the benefit of cardiac resynchronization therapy (CRT) to heart failure (HF) patients selected by QRS width 120-150 ms.
Objective: To test the hypothesis that CRT will have clinical benefit to patients with QRS width < 150 ms using an echo-guided lead placement strategy.
Methods: We analyzed the results of the Speckle Tracking Assisted Resynchronization Therapy for Electrode Region (STARTER) trial which was a prospective, randomized double-blind, controlled trial of 187 HF patients with QRS > 120 ms, and EF < 35%. We analyzed patients grouped by QRS width <150 vs. >150 ms. STARTER randomized patients 3:2 to LV lead guided to speckle tracking echo site of latest mechanical activation by speckle tracking echo radial strain vs. routine control. The predefined primary end-point was first HF hospitalization or death over 2 years. A Cox proportional hazards model with interaction terms was used.
Results: Of 187 patients enrolled, 14 had failed LV leads or were lost to follow-up, leaving 173. Mean QRS width was 159+ 26ms: 110 (64%) had QRS > 150 ms and 63 (36%) had QRS 120-150ms. There were 57 events over 2 years; 27 HF hospitalizations and 18 deaths. Overall, patients randomized to echoguided site of latest activation had significantly better event-free survival (p = 0.002). When analysed by baseline QRS width, patients with QRS 120-150ms appeared to gain the greatest benefit from the echo guided LV lead strategy, when compared with patients with QRS ≥ 150ms (p for interaction = 0.02).
Conclusion: Improved clincial outcome benefits of CRT to patients with QRS width 120-150ms may be gained by using a speckle tracking echo guided LV lead placement strategy. CRT outcome benefits of echo guided lead placement in narrower QRS patients exceed those to patients with QRS > 150ms. These observations have clinical implications for CRT. .
- © 2012 by American Heart Association, Inc.