Heart Failure
Conditions
Keywords
LBBB, Medical Therapy, Sinus Rhythm, Preserved LV Function
Brief summary
This trial will compare two management strategies for HF patients with preserved LV function in sinus rhythm and LBBB. The control group will be treated with practice guideline optimal medical therapy for HF. The experimental group will be treated with CRT in addition to optimal medical therapy for HF. In addition, the trial will further compare two methods of delivering CRT. One experimental group will receive BiV-CRT, while the second experimental group will receive CS-CRT.
Interventions
DEVICECRT
The experimental group will be treated with CRT in addition to optimal medical therapy for HF. In addition, the trial will further compare two methods of delivering CRT. One experimental group will receive BiV-CRT, while the second experimental group will receive CS-CRT
Sponsors
Anthony Tang
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This is a multi-centre randomized controlled trial with a prospective randomized open blinded endpoint trial (PROBE) design.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with NYHA class II-IVa HF symptoms and are on diuretic therapy * LVEF \> 35% (stratify by LVEF 36-49% and LVEF ≥ 50%), and recovered LVEF (previously LVEF ≤ 35%, but improved to LVEF \> 35% with medical therapy) * Patients with LVEF ≥ 50% must also have either left atrial enlargement (any of the following: LA diameter ≥3.8 cm, LA length ≥5.0 cm, LA volume ≥55 ml, LA volume index (LAVi) ≥29 mL/m2) or LV hypertrophy (LV mass index (LVMI) ≥115 g/m2 for males and ≥ 95g/m2 for females) * LBBB and QRS duration ≥ 140 msec. for men or ≥ 130 msec. for women, and with mid-QRS notching or slurring in ≥ 2 leads * Patients may have permanent RV pacing with a QRS duration ≥180ms * Patients may have permanent atrial fibrillation with good rate control defined as a resting heart rate of ≤80 bpm at rest and ≤110 bpm with 6-minute walk test * NT-proBNP ≥ 600 pg/ml on stable medical therapy without previous heart failure hospitalization in the last 12 months, or ≥400 pg/ml on stable medical therapy if there was a heart failure hospitalization within the previous 12 months * Appropriate pharmacological treatment of HF and co-morbidities. * Stable diuretic and other HF medications for at least four weeks
Exclusion criteria
* Serum creatinine \>180 μmol/L; or estimated glomerular filtration rate \[eGFR\] ≤30 mL/min/1.73 m2, calculated using the Modification of Diet in Renal Disease formula * In-hospital patients with acute cardiac or non-cardiac illness that requires intensive care * Acute coronary syndrome (including MI) \<4 weeks * Coronary revascularization (CABG or PCI) \< 3 months * Uncorrected or uncorrectable primary valvular disease * TAVI \< 3 months * Restrictive, or reversible form of cardiomyopathy, cardiac amyloidosis * Severe primary pulmonary disease such as cor pulmonale, primary pulmonary hypertension (may include secondary pulmonary hypertension, if mean pulmonary pressure is ≤ 70 mm Hg) * Expected to undergo cardiac transplantation within one year (status I) * Patients with a life expectancy of less than one year from non-cardiac cause. * Patients included in other clinical trials that will affect the objectives of this study * Patients who are pregnant/intend to get pregnant * Those unable or unwilling to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| NTproBNP measurement | 6 Months | The co-primary outcome measure is NTproBNP as measured at 6 months. |
| 6-minute walk distance | 6 Months | The co-primary outcome measure is 6 minute hall walk distance as measured at 6 months. |
| Quality of Life (QoL) score | 6 Months | The co-primary outcome measure is quality of life as measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score. The MLHFQ consists of 21 questions answered on a 0-5 likert scale, with higher scores indicating a stronger impact of heart failure on QoL. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| A composite of all-cause mortality and HF events | 6 Months | The secondary outcome measure a composite of all-cause mortality and HF events at 6 months. |
| Ventricular arrhythmia burden determined by the device capture of arrhythmias and adjudication by a device review committee blinded to patient's treatment allocation | 6 Months | The secondary outcome measure is Ventricular arrhythmia burden determined by the device as measured at 6 months. |
| Packer Composite Clinical Outcome Score | 6 Months | The secondary outcome measure is Packer Composite Clinical Outcome Score at 6 months. The Packer Clinical Composite Score classifies each patient into 1 of 3 categories (improved, worsened, unchanged), and is determined using clinical outcomes, heart failure status, and patient symptoms. Patients are considered improved if at the final visit they experienced in the patient assessment of a pre-specified scale but did not experience any major adverse clinical events throughout the trial. If considered worse, patients experienced a major clinical event during the planned duration of double-blind treatment or reported worsening at their final visit. And if considered unchanged, patients would be considered neither improved nor worse. |
| LV reverse remodeling (LVESVi on echocardiography) | 6 Months | The secondary outcome measure is LV reverse remodeling as measured by LVESVi on echocardiography at 6 months. |
| LVEF | 6 Months | The secondary outcome measure is LVEF as measured by echocardiography at 6 months. |
Countries
Canada
Outcome results
None listed