Abstract
Background
Conflicting data exist regarding the association between left ventricular (LV) lead
position and benefit from cardiac resynchronization therapy. We evaluated the relationships
between LV lead positions and the risk of death or hospitalization for heart failure
(HF) in the cardiac resynchronization therapy arm of the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT).
Methods
LV lead position was categorized by site investigator (MD) and in a chest radiograph
core laboratory (CXR) as “anterior,” “lateral,” or “posterior” in the short axis,
and “basal,” “mid,” or “apical” in the long axis. Agreement between MD and CXR LV
lead position classification was evaluated and the independent relationship between
LV lead position and clinical outcome was assessed using Cox multivariable models.
Results
Agreement between MD and CXR LV lead position was poor (κ ≤ 0.26). Over 39 ± 20 months,
140 of 447 (31.3%) patients met the RAFT primary end point (death or HF hospitalization).
In adjusted analyses, neither MD-determined nor CXR-determined anterior or apical
LV lead position was significantly associated with the primary outcome. However, CXR-defined
apical LV lead position was associated with a higher risk of HF hospitalization (hazard
ratio, 1.99; P = 0.004).
Conclusions
Poor agreement between implanting physician and core lab CXR-based categorizations
of LV lead position was observed. Neither categorization method resulted in significant
associations between apical or anterior LV lead position and the risk of the composite
primary outcome of death or heart failure hospitalization. However, CXR-defined apical
lead position was associated with increased risk of HF hospitalization.
Résumé
Introduction
Les données actuelles sur le lien entre la position de la sonde ventriculaire gauche
(VG) et les avantages du traitement de resynchronisation cardiaque sont contradictoires.
Nous avons évalué les liens entre les positions de la sonde VG et le risque de décès
ou d’hospitalisation liés à l’insuffisance cardiaque (IC) dans le bras de traitement
de resynchronisation cardiaque de l’essai RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial).
Méthodes
La position de la sonde VG a été classifiée par un chercheur (MD) sur le site et par
la radiographie thoracique (RXT) d’un laboratoire central comme étant « antérieure
», « latérale » ou « postérieure » dans le petit axe, et « basale », « moyenne » ou
« apicale » dans le grand axe. La concordance de la position de la sonde VG entre
la classification du MD et de la RXT a été évaluée, et le lien indépendant entre la
position de la sonde VG et le résultat clinique a été évalué à l’aide des modèles
multivariés de Cox.
Résultats
La concordance de la position de la sonde VG entre la classification du MD et de la
RXT était médiocre (κ ≤ 0,26). Au cours de 39 ± 20 mois, 140 des 447 (31,3 %) patients
ont répondu au critère de jugement principal RAFT (décès ou hospitalisation liés à
l’IC). Dans les analyses ajustées, ni la position antérieure ou apicale de la sonde
VG déterminée par le MD ni celle déterminée par la RXT n’ont été associées de manière
significative au critère de jugement principal. Cependant, la position apicale de
la sonde VG définie par la RXT a été associée à un risque plus élevé d’hospitalisation
liée à l’IC (rapport de risque, 1,99; P = 0,004).
Conclusions
Une concordance médiocre a été observée entre la mise en place des classifications
par le médecin et par la RXT du laboratoire central de la position de la sonde VG.
Aucune des méthodes de classification n’a mené à des liens significatifs entre la
position apicale ou antérieure de la sonde VG, et le risque du critère combiné principal
de décès ou d’hospitalisation liés à l’insuffisance cardiaque. Cependant, la position
apicale de la sonde définie par la RXT a été associée à l’augmentation du risque d’hospitalisation
liée à l’IC.
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Article info
Publication history
Published online: October 28, 2013
Accepted:
October 15,
2013
Received:
September 5,
2013
Footnotes
See page 419 for disclosure information.
Identification
Copyright
© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
