COMPArison of Multi-Point Pacing and ConvenTional CRT Through Non-invasive Hemodynamics Measurement: Short and Long Term Results of the COMPACT-MPP Study

Invasive hemodynamic studies have demonstrated improved left ventricular (LV) performances when cardiac resynchronization therapy/defibrillator (CRT-D) is delivered through multi-point pacing (MPP). Nowadays, strategies that allow to study the same hemodynamic parameters at a non-invasive level have become available. The aim of the present study was to evaluate the clinical implication of using a patient-tailored approach for CRT programming based on non-invasively assessed LV hemodynamics to identify the best biventricular pacing modality between standard single-site pacing (STD) and MPP for each patient. Fifty-one heart failure (HF) patients (age 69±9 years, 35 males, 27% ischemic etiology) implanted with CRT-D underwent non-invasive LV function assessment through photoplethysmography (PPG) before hospital discharge for addressing dP/dt and stroke volume in both pacing modalities (STD and MPP). The modality that performed better in terms of hemodynamic improvement was permanently programmed. Global Longitudinal Strain (GLS) was assessed as well, and repeated at three months. Compared to intrinsic rhythm (928±486 mmHg/s), dP/dt showed a trend to increase in both biventricular pacing modes (1000±577 mmHg/s in STD, 1036±530 mmHg/s in MPP, p=NS). MPP was associated with a wider hemodynamic improvement compared to STD, and was the modality of choice in 34/51 (67%) of patients. GLS at predischarge did not differ between groups (-10.3±3.8% vs. -10.2±3.5%), but significant improvement of EF at one month (34.4±5.3%, p