Abstract 12489: Resynchronization is Strongly Associated with Clinical Outcome Benefit in Echoguided Lead Placement: Results from STARTER Randomized Controlled Trial
Background: The Speckle Tracking Assisted Resynchronization Therapy for Electrode Region (STARTER) randomized 187 patients receiving cardiac resynchronization therapy (CRT) to speckle-tracking echo guided (EG) vs. routine left ventricular (LV) lead placement, demonstrating a significant reduction in heart failure hospitalizations or death using the EG approach.
Objective: To test the hypothesis that an important benefit of CRT is resynchronization of echocardiographic mechanical dyssynchrony.
Methods: There were 187 patients randomized to LV lead placed at either the site of latest activation determined by peak speckle tracking radial strain from basal and mid LV levels vs. a routine approach. Of these, 127 could be assessed for resynchronization from baseline and follow-up echo analyis. Resynchronized patients were defined as those with baseline dyssynchrony at least > 95 ms (anterior-septal to posterior wall strain delay) and > 50% reduction in dyssynchrony after CRT. The pre-specified primary endpoint was first heart failure (HF) hospitalization or death over 2 years. The pre-defined secondary end-point was death, transplant, or left ventricular assist device (LVAD).
Results: There were a total of 57 events over 2 years: 27 HF hospitalizations, 18 deaths, 6 LVADs and 1 transplant. Resynchronization was associated with a significant reduction in unfavorable primary and secondary end-point events after CRT (figure), p=0.0001 and p=0.01. Resynchronization was achieved more often in EG at 70% vs. 48% in the routine group (p = 0.02).
Conclusion: Resynchronization of echocardiographic dyssynchrony is strongly associated with clinical benefit after CRT, and provides mechanistic support. Resynchronization is achieved more often using EG lead placement and this approach has clincial implications. .
- © 2012 by American Heart Association, Inc.