Multipoint left ventricular pacing benefit to cardiac resynchronization therapy of heart failure; 5-year survival study (HUMVEE)

Abstract

Cardiac resynchronization therapy (CRT) is a fundamental component in the management of advanced heart failure (HF) characterized by electrical dyssynchrony. The aim of this study is to assess the capacity of optimized multipoint pacing (MPP) over CRT, in terms of clinical, functional, and echocardiographic parameters among dyssynchronous HF patients on 5-year cardiovascular disease mortality. HUMVEE was a single-center, phase-III clinical trial that enrolled 80 patients with dyssynchronous HF, under optimal medical treatment, eligible for CRT (male 77.5%, mean age 68±10 years). All patients underwent echocardiographically optimized CRT implantation and after six months allocated to either optimized MPP or remained to optimized CRT. Clinical, laboratory and echocardiographic assessment was conducted at baseline and at 6 and 12 months since baseline. Five-year survival was also assessed. During the 5-year follow-up, CVD mortality was 18 deaths (18/45, 40.0%) in the optimized MPP group, and 20 (20/35 57.1%) in the optimized CRT group (p log-rank = 0.035). Patients in optimized MPP group had 0.50-times lower risk of dying, compared to those who remained in optimized CRT (95%CI, [0.26, 0.95]). No significant differences were observed between baseline and 12-month follow-up measurements, in both groups. However, in the optimized MPP group, patients had better 6-minute walking distance at 12th-month of follow-up, compared to baseline evaluation, improved VTILVOT, stroke volume, LVEF, LA volume and RV strain (all p-values <0.05). Combining MPP with optimization, both electrical and hemodynamic, seems able to reverse the long-term progression of HF among dyssynchronous HF patients.Flow chartKM: Cummulative survival CRT vs MPP