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Reposted by American Heart Journal

American Heart Journal @americanheartj.bsky.social · 05/12/2023

Open Access: A review of polypills for the prevention of atherosclerotic cardiovascular disease. pubmed.ncbi.nlm.nih.gov/37634656/ CardioSky 🫀 🩺 Cardiology

Atherosclerotic cardiovascular disease (ASCVD) is a prevalent chronic condition managed through pharmacotherapy targeting modifiable risk factors. However, ASCVD patients often face poor medication adherence due to a high pill burden from multiple oral drugs, contributing to cardiovascular events. Recent evidence indicates that polypills combining antihypertensive and statin medications effectively control risk factors and improve adherence in various ASCVD risk patients. Randomized clinical trials demonstrate polypill efficacy in reducing major cardiovascular events, making them a convenient strategy for both established ASCVD patients and those without ASCVD. These positive results encourage the incorporation of polypills into comprehensive cardiovascular prevention programs, particularly for socio-economically vulnerable populations. Nevertheless, ...

More here: https://www.sciencedirect.com/science/article/pii/S0002870323002119

Figure 1: Rationale for single-pill combinations.

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Table 2. Randomized clinical trials of polypill to reduce adverse clinical events.

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Table 3. Polypills for cardiovascular prevention with marketing approval

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American Heart Journal @americanheartj.bsky.social · 11/12/2023

Open Access: Early computed tomography coronary angiography and preventative treatment in patients with suspected acute coronary syndrome: A secondary analysis of the RAPID-CTCA trial. pubmed.ncbi.nlm.nih.gov/37709109/ #CardioSky 🫀 🩺

Background: Computed tomography coronary angiography (CTCA) offers detailed assessment of the presence of coronary atherosclerosis and helps guide patient management. We investigated influences of early CTCA on the subsequent use of preventative treatment in patients with suspected acute coronary syndrome.

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Figure 1. Study flowchart.

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Figure 2. Prescription of preventative treatment.

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Figure 3. Between-subgroup differences in prescription of preventative treatment.

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American Heart Journal @americanheartj.bsky.social · 08/12/2023

Open Access: Rationale and design of the DAPA-MI trial: Dapagliflozin in patients without diabetes mellitus with acute myocardial infarction. pubmed.ncbi.nlm.nih.gov/37648579/ #CardioSky 🫀 🩺 Cardiology

Background
Therapies that could further prevent the development of heart failure (HF) and other cardiovascular and metabolic events in patients with recent myocardial infarction (MI) represent a large and unmet medical need.

Methods
DAPA-MI is a multicenter, parallel-group, registry-based, randomized, double-blind, placebo-controlled phase 3 trial in patients without known diabetes or established HF, presenting with MI and impaired left ventricular systolic function or Q-wave MI.

More here: https://www.sciencedirect.com/science/article/pii/S0002870323002077?via%3Dihub

Figure 1. Trial outline. MI, myocardial infarction; MINAP, Myocardial Ischaemia National Audit Project

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Table 2. Outcomes

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Table 1. DAPA-MI inclusion/exclusion criteria

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American Heart Journal @americanheartj.bsky.social · 05/12/2023

Open Access: Randomized controlled trial of mechanical thrombectomy vs catheter-directed thrombolysis for acute hemodynamically stable pulmonary embolism: Rationale and design of the PEERLESS study. pubmed.ncbi.nlm.nih.gov/37703948/ #CardioSky 🫀 🩺 Cardiology

Background
The identification of hemodynamically stable pulmonary embolism (PE) patients who may benefit from advanced treatment beyond anticoagulation is unclear. However, when intervention is deemed necessary by the PE patient's care team, data to select the most advantageous interventional treatment option are lacking. Limiting factors include major bleeding risks with systemic and locally delivered thrombolytics and the overall lack of randomized controlled trial (RCT) data for interventional treatment strategies. Considering the expansion of the pulmonary embolism response team (PERT) model, corresponding rise in interventional treatment, and number of thrombolytic and nonthrombolytic catheter-directed devices coming to market, robust evidence is needed to identify the safest and most effective interventional option for patients.

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Graphical abstract.

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Table 3: Hierarchal win ratio primary end point

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Table 1. Inclusion and exclusion eligibility criteria

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American Heart Journal @americanheartj.bsky.social · 05/12/2023

Open Access: A review of polypills for the prevention of atherosclerotic cardiovascular disease. pubmed.ncbi.nlm.nih.gov/37634656/ CardioSky 🫀 🩺 Cardiology

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Reposted by American Heart Journal

American Heart Journal @americanheartj.bsky.social · 12/11/2023

Open Access: Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol. pubmed.ncbi.nlm.nih.gov/37479162/ #CardioSky 🫀 🩺

Background: Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions.

More here: https://pubmed.ncbi.nlm.nih.gov/37479162/

Study Design.

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Figure 2. Aktiia mobile phone application and blood pressure titration strategy.

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Table II. Primary and secondary outcomes for the NEXTGEN-BP trial

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American Heart Journal @americanheartj.bsky.social · 12/11/2023

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American Heart Journal @americanheartj.bsky.social · 06/11/2023

Open Access: An investigator-sponsored pragmatic randomized controlled trial of AntiCoagulation vs AcetylSalicylic Acid after Transcatheter Aortic Valve Implantation: Rationale and design of ACASA-TAVI. pubmed.ncbi.nlm.nih.gov/37634655/ #CardioSky 🫀 🩺

Background: The optimal antithrombotic therapy after transcatheter aortic valve implantation (TAVI) is unknown. Bioprosthetic valve dysfunction (BVD) is associated with adverse outcomes and may be prevented by anticoagulation therapy. A dedicated randomized trial comparing monotherapy NOAC to single antiplatelet therapy has not been performed previously. We hypothesize that therapy with any anti-factor Xa NOAC will reduce BVD compared to antiplatelet therapy, without compromising safety.

More here: https://pubmed.ncbi.nlm.nih.gov/37634655/

Figure 1. Study design. *Dose reduction according to the drug label. Apixaban 2.5 mg twice daily if 2 of the following: (1) age ≥80 years (not relevant at inclusion but may occur during follow-up), (2) body weight ≤60 kg, serum creatinine ≥1.5 mg/dL [133 µmol/L]. Rivaroxaban 15 mg daily if creatinine clearance 15 to 49 mL/min. Edoxaban 30 mg daily if one of the following: (1) Creatinine clearance 15 to 50 mL/min, (2) body weight ≤60 kg, (3) concomitant use of the following P-glycoprotein inhibitors (cyclosporine, dronedarone, erythromycin, or ketoconazole).

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Figure 2. Trial timeline.

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Figure 4. Randomized controlled trials comparing different antithrombotic strategies after transcatheter aortic valve implantation.

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American Heart Journal @americanheartj.bsky.social · 05/11/2023

Open Access: The coronary microvascular angina cardiovascular magnetic resonance imaging trial: Rationale and design. pubmed.ncbi.nlm.nih.gov/37657593/ #CardioSky 🫀 🩺 Cardiology

Background: Coronary microvascular dysfunction may cause myocardial ischemia with no obstructive coronary artery disease (INOCA). If functional testing is not performed INOCA may pass undetected. Stress perfusion cardiovascular MRI (CMR) quantifies myocardial blood flow (MBF) but the clinical utility of stress CMR in the management of patients with suspected angina with no obstructive coronary arteries (ANOCA) is uncertain.

Objectives: First, to undertake a diagnostic study using stress CMR in patients with ANOCA following invasive coronary angiography and, second, in a nested, double-blind, randomized, controlled trial to assess the effect of disclosure on the final diagnosis and health status in the longer term.

More here: https://pubmed.ncbi.nlm.nih.gov/37657593/

Figure 1. Myocardial perfusion maps revealing normal perfusion and microvascular dysfunction.

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Figure 2. Study design.
Figure 3. Recruitment sites for the CorCMR trial. Three recruiting hospitals with a catchment area which covers West and Central Scotland.

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Figure 4. CorCMR CMR protocol.

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American Heart Journal @americanheartj.bsky.social · 03/11/2023

Open Access: Importance of familial predisposition to heart failure to the risk of anthracycline-related cardiotoxicity: A nationwide study. pubmed.ncbi.nlm.nih.gov/37453730/ #CardioSky 🫀 🩺

Background: Anthracycline-based chemotherapy has improved the prognosis of various malignancies, but increases the long-term risk of heart failure (HF). Identification of patients at risk prior to treatment initiation is warranted. Therefore, the aim of this study was to evaluate if a familial predisposition to HF increases the risk of anthracycline related HF.

Methods: Using nationwide Danish registries, all patients treated with anthracycline from 2004 to 16 were identified. The primary outcome was long-term HF risk. First-degree relatives were identified in the Danish Family Registry and exposure was defined as a first-degree biological relative with prior HF. Risk of HF was evaluated in a cumulative incidence function and the association in a multivariable Cox regression model.

More at: https://pubmed.ncbi.nlm.nih.gov/37453730/

Key Points:

1)
Anthracycline-based chemotherapy is associated with the development of heart failure.

2)
Research has suggested that genetic variations associated with cardiomyopathies may increase the risk of heart failure associated with anthracycline.

3)
The aim of this study was to evaluate if a familial predisposition to HF increases the risk of anthracycline related HF.

4)
In this nationwide register-based study family incident heart failure is associated with a small but increased risk of anthracycline related heart failure.

5)
Attention towards the family predisposition, when estimating the risk of cancer therapy related cardiotoxicity is relevant.

Figure 2. Cumulative incidence of heart failure with death as competing event.

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Figure 3. Forrest plot illustrating the Cox Proportional Hazard model estimates for HF associated with anthracycline treatment and familial predisposition.

Figure 4. Kaplan-Meier estimate of all-cause mortality.

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American Heart Journal @americanheartj.bsky.social · 22/10/2023

Open Access: The effect of vitamin D3 supplementation on atrial fibrillation in generally healthy men and women: The Finnish Vitamin D Trial. pubmed.ncbi.nlm.nih.gov/37302737/ #CardioSky 🫀 🩺

Atrial fibrillation is a common cardiac arrhythmia with high morbidity risk. Observational studies suggest that vitamin D deficiency is associated with higher atrial fibrillation risk but there is limited evidence whether vitamin D supplementation could affect the risk. In these post hoc analyses from the Finnish Vitamin D Trial, we compared the incidence of atrial fibrillation with 5-year supplementation of vitamin D3 (1600 IU/d or 3200 IU/d) vs placebo.

More here: https://pubmed.ncbi.nlm.nih.gov/37302737/

Figure 2. Cumulative incidence of atrial fibrillation in the 3 study arms.

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Table II. Hazard of atrial fibrillation in the 3 supplementation arms.

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Figure 1. Participant flow chart.

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American Heart Journal @americanheartj.bsky.social · 12/10/2023

In Press, Open Access: Angiotensin receptor blockers in patients with hypertrophic cardiomyopathy: A comparison of VANISH and INHERIT randomized trials. www.sciencedirect.com/science/arti... #CardioSky 🫀

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American Heart Journal @americanheartj.bsky.social · 10/10/2023

Impact of standard modifiable cardiovascular risk factors on 2-year all-cause mortality: Insights from an international cohort of 23,489 patients with acute coronary syndrome. pubmed.ncbi.nlm.nih.gov/37279841/ #CardioSky 🫀🩺

Background: Controversial findings have been reported in the literature regarding the impact of the absence of standard modifiable cardiovascular risk factors (SMuRFs) on long-term mortality risk in patients with acute coronary syndrome (ACS). While the prognostic additive value of SMuRFs has been well described, the prognostic role of prior cardiovascular disease (CVD) by sex is less well-known in patients with and without SMuRFs.

More at: https://pubmed.ncbi.nlm.nih.gov/37279841/

Figure 1. Kaplan–Meier estimate of the cumulative probability of death for patients with and without SMURF in the whole cohort, and stratified by sex, age, and type of ACS. Panel A shows a Kaplan Meier survival curve for unadjusted 2-year all-cause death by SMuRFs, whereas stratified analyses are shown in the other panels: by sex (panels B and C), by age (panels D and E), and by type of acute coronary syndrome (panels F and G). Interaction P-values for sex was .796, for age .810, and for type of ACS .576. There was no interaction with race (P = .212).

Table II. In hospital management and discharge treatment in patient without and with SMuRFs

Table III. Risk of 2-year all-cause post discharge mortality according to the presence or absence of SMuRFs

More at: https://www.sciencedirect.com/science/article/abs/pii/S0002870323001394

Figure 2. Additive prognostic value of SMuRFs and prior CVD. (A) Kaplan Meier survival curve for 2-year all-cause death by SMuRFs and CVD; (B) Adjusted HRs for all combinations of sex, SMURF, and CVD are plotted in this panel. Wald tests for linear combinations using Cox proportional hazards models were used to evaluate the time to the first occurrence of 2-year all-cause mortality, with stratification according to geographic region and adjustment for the full model including baseline, index event, and management data.

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American Heart Journal @americanheartj.bsky.social · 05/10/2023

Open Access: Rationale and design of a randomized study comparing the Watchman FLX device to DOACs in patients with atrial fibrillation. pubmed.ncbi.nlm.nih.gov/37279840/ #CardioSky 🫀🩺

Background: Percutaneous left atrial appendage (LAA) closure (LAAC) was developed as a nonpharmacologic alternative to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) who are at an increased risk for stroke or systemic embolism. The Watchman device permanently seals off the LAA to prevent thrombi from escaping into the circulation. Previous randomized trials have established the safety and efficacy of LAAC compared to warfarin. However, direct OACs (DOACs) have become the preferred pharmacologic strategy for stroke prevention in patients with AF, and there is limited data comparing Watchman FLX to DOACs in a broad AF patient population. CHAMPION-AF is designed to prospectively determine whether LAAC with Watchman FLX is a reasonable first-line alternative to DOACs in patients with AF who are indicated for OAC therapy.

More here: https://www.sciencedirect.com/science/article/pii/S0002870323001400?via%3Dihub

Figure. CHAMPION AF study design. *baseline testing includes TTE, modified Rankin scale (MRS) and NIH stroke scale (NIHSS), quality of life questionnaires (SF-12/EQ-5D-5L) and Montreal cognitive assessment (MoCA).

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Table II. Statistical analysis of primary end points.

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Table III. Statistical analysis of secondary end points.

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American Heart Journal @americanheartj.bsky.social · 04/10/2023

Open Access: Patient characteristics and long-term outcomes in patients undergoing transcatheter aortic valve implantation in a failed surgical prosthesis vs in a native valve: A Danish nationwide study. pubmed.ncbi.nlm.nih.gov/37178995/ #CardioSky 🫀🩺

Background: Valve-in-valve-transcatheter aortic valve implantation (TAVI) is a feasible and increasingly used treatment option for failed surgical aortic prosthesis, but data from clinical practice are limited. We aimed to examine patient characteristics and outcomes of patients undergoing TAVI in a surgival valve (valve-in-valve TAVI) compared with patients undergoing TAVI in a native valve.

More here: https://www.sciencedirect.com/science/article/pii/S0002870323001187?via%3Dihub

Figure 2. Mortality and readmissions after TAVI in a native valve or in a failed surgical aortic prosthesis. A) Mortality in patients with TAVI in a failed surgical aortic prosthesis or in a native valve. B) Readmissions in patients with TAVI in a failed surgical aortic prosthesis or in a native valve. TAVI transcatheter aortic valve implantation; SAVR surgical aortic valve replacement.

Table II. Mortality and readmissions after TAVI in a native valve or in a failed surgical aortic prosthesis.

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Table I. Baseline characteristics of study population.

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American Heart Journal @americanheartj.bsky.social · 03/10/2023

Open Access: Incorporating a polygenic risk score-triaged coronary calcium score into cardiovascular disease examinations to identify subclinical coronary artery disease (ESCALATE): Protocol for a prospective, nonrandomized implementation trial. pubmed.ncbi.nlm.nih.gov/37364748/ #CardioSky 🫀

Background: Identifying and targeting established modifiable risk factors has been a successful strategy for reducing the burden of coronary artery disease (CAD) at the population-level. However, up to 1-in-4 patients who present with ST elevation myocardial infarction do so in the absence of such risk factors. Polygenic risk scores (PRS) have demonstrated an ability to improve risk prediction models independent of traditional risk factors and self-reported family history, but a pathway for implementation has yet to be clearly identified. The aim of this study is to examine the utility of a CAD PRS to identify individuals with subclinical CAD via a novel clinical pathway, triaging low or intermediate absolute risk individuals for noninvasive coronary imaging, and examining the impact on shared treatment decisions and participant experience.

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Figure 1. ESCALATE study diagram.

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Table I. ESCALATE study outcome measures.

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Reposted by American Heart Journal

Shoa Clarke @shoaclarke.bsky.social · 29/09/2023

📢 Calling all cardiologists and cardiology enthusiasts📢 I've created a CardioSky feed! It pulls posts marked with #CardioSky as well as posts that link to articles from cardiology journals. Check it out! bsky.app/profile/did:...

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American Heart Journal @americanheartj.bsky.social · 02/10/2023

Open Access: Hemodialysis and its impact on patient characteristics, microbiology, cardiac surgery, and mortality in infective endocarditis. pubmed.ncbi.nlm.nih.gov/37271357/ #CardioSky #Cardiology

Background: Patients with chronic renal failure on hemodialysis carry a significant risk of infective endocarditis (IE), but data on whether these patients differ from other patients with IE in terms of comorbidity, microbiology, rates of surgery and mortality are sparse.

Methods: Using Danish nationwide registries, all patients with IE diagnosed between February 1, 2010, and May 14, 2018 were identified and categorized into a "hemodialysis group" and a "non-hemodialysis group." Patient groups were compared by comorbidities, microbiological etiology, cardiac surgery, and mortality. Risk factors associated with mortality were assessed in multivariable Cox regression analysis.

More here: https://www.sciencedirect.com/science/article/pii/S0002870323001357?via%3Dihub

Figure 2. Microbiological etiology of infective endocarditis: The figure shows pie charts with distribution of microbiological etiology of infective endocarditis in the hemodialysis group and the non-hemodialysis group, respectively.

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Figure 3. Cumulative incidences of mortality from hospital admission: The figure shows cumulative incidences of mortality in the hemodialysis group and the non-hemodialysis group, respectively. The patients were followed from hospital admission and up to 5 years of follow-up.

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Figure 4. Cumulative incidences of mortality from hospital discharge: The figure shows cumulative incidences of mortality in the hemodialysis group and the non-hemodialysis group, respectively. The patients were followed from hospital discharge and up to 5 years of follow-up.

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American Heart Journal @americanheartj.bsky.social · 25/09/2023

Open Access: Ultrathin-strut vs thin-strut drug-eluting stents for multi and single-stent lesions: A lesion-level subgroup analysis of 2 randomized trials. pubmed.ncbi.nlm.nih.gov/37192697/ #CardioSky #Cardiology

Background: Whether ultrathin-strut stents are particularly beneficial for lesions requiring implantation of more than 1 stent is unknown.

Methods: In a post-hoc lesion-level analysis of 2 randomized trials comparing ultrathin-strut biodegradable polymer Sirolimus-eluting stents (BP-SES) vs thin-strut durable polymer Everolimus-eluting stents (DP-EES), lesions were stratified into multistent lesions (MSL) vs single-stent lesions (SSL). The primary endpoint was target lesion failure (TLF), a composite of lesion-related unclear/cardiac death, myocardial infarction (MI), or revascularization, at 24 months.

More here: https://pubmed.ncbi.nlm.nih.gov/37192697/

Figure 1. Lesion-level event adjudication. Every clinical event was classified as either clearly attributable, possibly attributable, or not attributable to a specific lesion. Diagrams show the proportion of each class of event. Examples are provided below. The primary analysis included all clearly and possibly attributable events, for the sensitivity analysis only clearly attributable events were included.

Figure 2. Time-to-event curves. Time-to-event curves for: A, target lesion failure, B, target lesion-related myocardial infarction (MI) or target lesion revascularization (TLR), C, target lesion-related myocardial infarction, and D) target lesion revascularization (TLR) clearly or possibly attributed to at 2-year follow-up (primary analysis). Red lines, ultrathin-strut biodegradable Sirolimus-eluting stent (BP-SES); blue lines, thin-strut durable polymer Everolimus-eluting stent (DP-EES); solid lines, multistent lesions (MSL); dashed lines, single-stent lesions (SSL). SHR, subdistribution hazard ratios with 95% confidence intervals.

More here: https://pubmed.ncbi.nlm.nih.gov/37192697/

Central Illustration. Lesion stratification and event rates at 2 years. Lesion stratification (left side). Proportion of single-stent lesions (SSL) is indicated by dashed areas, multistent lesions (MSL) by solid areas. Colours indicate stratification by stent type (red for ultrathin-strut biodegradable polymer Sirolimus-eluting stents [BP-SES], blue thin-strut durable polymer Everolimus-eluting stents [DP-EES]). Event rates at 2 years (right side). Event rates (primary analysis including all clearly and possibly attributable events) stratified by lesion and stent type for the primary endpoint of lesion-level-adjudicated target lesion failure (TLF) and the secondary composite endpoint of lesion-related myocardial infarction (MI) or target lesion revascularization (TLR).

More here: https://pubmed.ncbi.nlm.nih.gov/37192697/

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American Heart Journal @americanheartj.bsky.social · 25/09/2023

Open Access: Operational challenges and mitigation measures during the COVID-19 pandemic-Lessons from DELIVER. pubmed.ncbi.nlm.nih.gov/37220822/ #CardioSky #Cardiology 🩺

Background Catastrophic disruptions in care delivery threaten the operational efficiency and potentially the validity of clinical research efforts, in particular randomized clinical trials. Most recently, the COVID-19 pandemic affected essentially all aspects of care delivery and clinical research conduct. While consensus statements and clinical guidance documents have detailed potential mitigation measures, few real-world experiences detailing clinical trial adaptations to the COVID-19 pandemic exist, particularly among, large, global registrational cardiovascular trials.

More here: https://www.sciencedirect.com/science/article/pii/S0002870323001321

Timeline of mitigation activities in the DELIVER trial during the COVID-19 pandemic.

More here: https://www.sciencedirect.com/science/article/pii/S0002870323001321

Figure 2. Study calendar in relation to the COVID-19 pandemic

Legend: This figure shows enrollment through follow-up for each randomized participant in the DELIVER trial. March 11, 2020, corresponds to the date of the World Health Organization (WHO) declaration of COVID-19 as a pandemic.

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Figure 3. Recruitment over time in DELIVER

This shows a marked decrease in enrollment from March 2020 through January 2021.

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American Heart Journal @americanheartj.bsky.social · 23/09/2023

Open Access: PROTEUS Study: A Prospective Randomized Controlled Trial Evaluating the Use of Artificial Intelligence in Stress Echocardiography. pubmed.ncbi.nlm.nih.gov/37192698/ #CardioSky #Cardiology

Background: Stress echocardiography (SE) is one of the most commonly used diagnostic imaging tests for coronary artery disease (CAD) but requires clinicians to visually assess scans to identify patients who may benefit from invasive investigation and treatment. EchoGo Pro provides an automated interpretation of SE based on artificial intelligence (AI) image analysis. In reader studies, use of EchoGo Pro when making clinical decisions improves diagnostic accuracy and confidence. Prospective evaluation in real world practice is now important to understand the impact of EchoGo Pro on the patient pathway and outcome.

More here: https://www.sciencedirect.com/science/article/pii/S000287032300114X?via%3Dihub

Table I. PROTEUS trial objectives and outcome measures

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Figure 1. PROTEUS Study overview and visit schedule. Provides an overview of the study, describing the inclusion/exclusion criteria, randomization arms, and study visits.

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American Heart Journal @americanheartj.bsky.social · 23/09/2023

Open Access: Does targeted positioning of the left ventricular pacing lead towards the latest local electrical activation in cardiac resynchronization therapy reduce the incidence of death or hospitalization for heart failure? pubmed.ncbi.nlm.nih.gov/37220821/ #CardioSky #Cardiology

Background: Cardiac resynchronization therapy (CRT) improves symptoms, health-related quality of life and long-term survival in patients with systolic heart failure (HF) and shortens QRS duration. However, up to one third of patients attain no measurable clinical benefit from CRT. An important determinant of clinical response is optimal choice in left ventricular (LV) pacing site. Observational data have shown that achieving an LV lead position at a site of late electrical activation is associated with better clinical and echocardiographic outcomes compared to standard placement, but mapping-guided LV lead placement towards the site of latest electrical activation has never been investigated in a randomized controlled trial (RCT). The purpose of this study was to evaluate the effect of targeted positioning of the LV lead towards the latest electrically activated area. We hypothesize that this strategy is superior to standard LV lead placement.

More here: https://pubmed.ncbi.nlm.nih.go

Fig. 1. Placement of the LV lead in the intervention group. Timing of local electrical activation measuring form RV activation to the first large deflection on the LV EGM is recorded in all CS branches where an LV lead may potentially be positioned using the LV lead or an electrically active guidewire. The LV lead is positioned in the CS branch with the latest local electrical activation if lead stability, pacing threshold and threshold for phrenic nerve stimulation are acceptable.

Inclusion Criteria

Age >40 years
Heart failure, NYHA II or III, or outpatient IV
LVEF ≤35% measured by echocardiography
Optimal medical treatment for heart failure*
Bundle branch block, defined as one of the following:
True LBBB according to AHA/ACC/HRS Scientific Statement from 200918 † and ≥130ms
2LBBB-like, intraventricular conduction delay (IVCD), right bundle branch block (RBBB), all >150ms or
3RV paced QRS and indication for upgrade to CRT (>50% RV pacing) or
4RV pacing indicated by bradycardia with expected large percentage of RV pacing
Indication for primary CRT-D or CRT-P implantation or upgrade from RV pacing (pacemaker or ICD) to CRT-D or CRT-P.
Heart failure due to ischemic heart disease (IHD) or non-IHD
Sinus rhythm or atrial fibrillation
Life expectancy >2 years
Signed informed consent

Exclusion criteria:
AMI within the latest 3 months

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Table III. Data collection in the DANISH-CRT trial.

More here: https://www.sciencedirect.com/science/article/pii/S0002870323001291?via%3Dihub#tbl0003

010