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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EResults from the Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy Study [TARGET; \u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN19717943\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN19717943\u003C\/a\u003E] show that targeted left ventricular lead placement not only is feasible but results in enhanced cardiac resynchronization therapy response.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EResults from the Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy Study (TARGET; \u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN19717943\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN19717943\u003C\/a\u003E), presented by Fakhar Z. Khan, MD, Addenbrooke\u0027s Hospital, Cambridge, UK, show that targeted left ventricular (LV) lead placement not only is feasible but results in enhanced cardiac resynchronization therapy (CRT) response. Concordant LV lead placement, baseline dyssynchrony, and pacing away from areas of the scar are strongly related to improved CRT outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ECRT has become part of the standard treatment for patients with advanced heart failure (HF) symptoms, impaired LV systolic function, and intraventricular conduction delay. Lead placement has emerged as a determinant of response. The objective of the TARGET Study was to prospectively assess the feasibility of a targeted approach to LV lead placement and the impact of LV lead targeting on CRT outcomes. The hypothesis was that targeting LV lead placement to the latest site of contraction using speckle tracking echocardiography would enhance CRT response when compared with standard unguided treatment.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ETARGET was a single-blind, prospective, randomized, controlled trial in patients with New York Heart Association (NYHA) Class III\u2013IV, left ventricular ejection fraction \u0026lt;35%, and QRS width \u0026gt;120 ms, despite maximally tolerated doses of standard HF treatment (eg, diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and aldosterone antagonists).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ESubjects were randomly assigned to receive targeted LV lead placement using speckle tracking echocardiography [Goffinet C \u0026amp; Vanoverschelde J-L. \u003Cem\u003EEur Cardiology\u003C\/em\u003E 2007] to identify the optimal site for LV lead placement (n=110; Target Group) or standard (unguided) lead placement (n=110; Control Group). All underwent the echo procedure to identify an optimal pacing site, but in the control group, the leads were positioned with blinding to the echo data. Each placement was categorized as to whether the LV lead was positioned at the optimal site.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAll CRT devices were optimized using echo following implantation. The primary endpoint was a \u0026gt;15% reduction in left ventricular end systolic volume (LVESV) at 6 months. Secondary endpoints were a \u22651-step improvement in NYHA Class, all-cause mortality, and a combination of mortality and HF hospitalization.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EData for 207 subjects (103 subjects in the Target Group and 104 controls) were available for analysis. Subjects had a mean age of 70 years, approximately 86% were men, and about 94% of subjects were NYHA Class III\/IV. More than half (56%) of subjects had underlying cardiomyopathy.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EReduction in LVESV at 6 months (the primary endpoint) was significantly higher in subjects who received targeted lead placement compared with those who received standard lead placement (70% vs 55%; p=0.031). The group who used echo guidance had had the lead placed in an optimal position significantly more often than those who did not have echo guidance (p=0.011). Subjects in the Target Group also showed significant improvements in NYHF Class (p=0.002), the 6-minute walk test (p=0.01), and improved scores on the Minnesota Living with Heart Failure questionnaire (p=0.02). There was a significant (p=0.03) difference in the combined secondary endpoint of death and HF hospitalization, favoring the Target Group. All-cause mortality did not differ.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ETargeted LV lead placement using speckle tracking 2D is feasible and associated with greater LV reverse remodeling, clinical response, and freedom from death and HF-related hospitalization. Concordant LV lead placement, baseline dyssynchrony, and pacing away from areas of the scar are strongly related to improved CRT outcomes. The speckle tracking echo technique is available for clinical use, making these results applicable to a wide range of clinical centers.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/3\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn361\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}