Predictors of the efficacy of His bundle pacing in patients with a prolonged PR interval: A stratified analysis of the HOPE‐HF randomized controlled trial,European Journal of Heart Failure

当前位置： X-MOL 学术 › Eur. J. Heart Fail. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Predictors of the efficacy of His bundle pacing in patients with a prolonged PR interval: A stratified analysis of the HOPE‐HF randomized controlled trial
European Journal of Heart Failure ( IF 16.9 ) Pub Date : 2024-07-18 , DOI: 10.1002/ejhf.3367
Daniel Keene _{1,

2} , Nandita Kaza _{1,

2} , Divya Srinivasan ₂ , Nadine Ali _{1,

2} , Mark Tanner ₃ , Paul Foley ₄ , Badri Chandrasekaran ₄ , Philip Moore _{5,

6} , Shaumik Adhya ₇ , Norman Qureshi ₈ , Amal Muthumala _{6,

9} , Rebecca Lane ₁₀ , Aldo Rinaldi ₁₁ , Sharad Agarwal ₁₂ , Francisco Leyva ₁₃ , Jonathan Behar ₁₀ , Sukh Bassi ₁₄ , Andre Ng ₁₅ , Paul Scott ₁₆ , Rachana Prasad ₁₇ , Jon Swinburn ₁₈ , Joseph Tomson ₁₉ , Amarjit Sethi ₂₀ , Jaymin Shah ₂₀ , Phang Boon Lim ₁ , Andreas Kyriacou ₂₁ , Dewi Thomas ₂₂ , Jenny Chuen ₂₃ , Ravi Kamdar ₂₄ , Prapa Kanagaratnam ₁ , Myril Mariveles ₂ , Nicholas Johnson ₂₅ , Emanuela Falaschetti ₂₅ , James P Howard ₁ , Ahran Arnold _{1,

2} , John G F Cleland ₂₆ , Darrel P Francis ₁ , Zachary Whinnett ₁ , Matthew Shun-Shin _{1,

2}

Affiliation

National Heart and Lung Institute, Imperial College London, London, UK.
Imperial College Healthcare NHS Trust, London, UK.
West Sussex Hospitals NHS Trust, West Sussex, UK.
Great Western Hospitals NHS Foundation Trust, Swindon, UK.
West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK.
Barts Health NHS Trust, London, UK.
Medway NHS Foundation Trust, Kent, UK.
Wycombe General Hospital, High Wycombe, UK.
North Middlesex University Hospital, London, UK.
Royal Brompton and Harefield NHS Trust, London, UK.
Guy's and St. Thomas's NHS Foundation Trust, London, UK.
Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
University Hospitals Birmingham, Birmingham, UK.
Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK.
Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
Kings College NHS Hospital, London, UK.
Kettering General Hospital, Northampton, UK.
Royal Berkshire NHS Foundation Trust, Reading, UK.
Royal Free London Foundation NHS Trust, London, UK.
London North West University Healthcare NHS Trust, London, UK.
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Morriston Hospital Regional Cardiac Centre, Swansea, UK.
Nottingham University Hospitals NHS Trust, Nottingham, UK.
Croydon NHS University Hospital, London, UK.
Imperial College Trials Unit, Imperial College London, London, UK.
School of Health and Wellbeing, University of Glasgow, Glasgow, UK.

AimsThe randomized, double‐blind, placebo‐controlled HOPE‐HF trial assessed the benefit of atrio‐ventricular (AV) delay optimization delivered using His bundle pacing. It recruited patients with left ventricular ejection fraction ≤40%, PR interval ≥200 ms, and baseline QRS ≤140 ms or right bundle branch block. Overall, there was no significant increase in peak oxygen uptake (VO2max) but there was significant improvement in heart failure specific quality of life. In this pre‐specified secondary analysis, we evaluated the impact of baseline PR interval, echocardiographic E‐A fusion, and the magnitude of acute high‐precision haemodynamic response to pacing, on outcomes.Methods and resultsAll 167 randomized participants underwent measurement of PR interval, acute haemodynamic response at optimized AV delay, and assessment of presence of E‐A fusion. We tested the impact of these baseline parameters using a Bayesian ordinal model on VO2max, quality of life and activity measures. There was strong evidence of a beneficial interaction between the baseline acute haemodynamic response and the blinded benefit of pacing for VO2 (Pr 99.9%), Minnesota Living With Heart Failure (MLWHF) (Pr 99.8%), MLWHF physical limitation score (Pr 98.9%), EQ‐5D visual analogue scale (Pr 99.6%), and exercise time (Pr 99.4%). The baseline PR interval and the presence of baseline E‐A fusion did not have this reliable ability to predict the clinical benefit of pacing over placebo across multiple endpoints.ConclusionsIn the HOPE‐HF trial, the acute haemodynamic response to pacing reliably identified patients who obtained clinical benefit. Patients with a long PR interval (≥200 ms) and left ventricular impairment who obtained acute haemodynamic improvement with AV‐optimized His bundle pacing were likely to obtain clinical benefit, consistent across multiple endpoints. Importantly, this gradation can be reliably tested for before randomization, but does require high‐precision AV‐optimized haemodynamic assessment to be performed.

中文翻译：

希氏束起搏对 PR 间期延长患者疗效的预测因素：HOPE-HF 随机对照试验的分层分析

目的随机、双盲、安慰剂对照 HOPE-HF 试验评估了使用希氏束起搏实现房室 (AV) 延迟优化的益处。它招募了左心室射血分数≤40%、PR间期≥200毫秒、基线QRS≤140毫秒或右束支传导阻滞的患者。总体而言，峰值摄氧量（VO 2 max），但心力衰竭特定的生活质量有显着改善。在这项预先指定的二次分析中，我们评估了基线 PR 间期、超声心动图 E-A 融合以及对起搏的急性高精度血流动力学反应程度对结果的影响。方法和结果所有 167 名随机参与者均接受了 PR 间期测量、优化 AV 延迟时的急性血流动力学反应，以及 E-A 融合存在的评估。我们使用贝叶斯序数模型测试了这些基线参数对 VO 的影响2最大、生活质量和活动测量。有强有力的证据表明，基线急性血流动力学反应与 VO 起搏的盲法益处之间存在有益的相互作用2 (Pr 99.9%)、明尼苏达心力衰竭 (MLWHF) (Pr 99.8%)、MLWHF 身体限制评分 (Pr 98.9%)、EQ-5D 视觉模拟量表 (Pr 99.6%) 和运动时间 (Pr 99.4%) 。基线 PR 间期和基线 E-A 融合的存在不具有这种可靠的能力来预测起搏相对于安慰剂在多个终点的临床益处。结论在 HOPE-HF 试验中，对起搏的急性血流动力学反应可靠地识别了获得以下结果的患者：临床获益。 PR 间期长（≥200 毫秒）且左心室受损的患者通过 AV 优化希氏束起搏获得急性血流动力学改善，可能会获得临床获益，这在多个终点上是一致的。重要的是，这种分级可以在随机化之前进行可靠的测试，但确实需要进行高精度 AV 优化的血液动力学评估。

更新日期：2024-07-18

点击分享查看原文

点击收藏

公开下载

阅读更多本刊新发论文本刊介绍/投稿指南