Document Detail


Cardiac resynchronization therapy in patients with mild heart failure: a systematic review and meta-analysis.
MedLine Citation:
PMID:  21594629     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Cardiac resynchronization therapy (CRT) reduces symptoms and improves survival in patients with advanced heart failure (New York Heart Association (NYHA) functional class III-IV), reduced ejection fraction, and wide QRS complex. Whether CRT has the same benefit also in asymptomatic or mildly symptomatic heart failure patients is controversial. Our objective is to summarize the available evidence on the effects of CRT in asymptomatic or mildly symptomatic (NYHA I-II) heart failure patients. METHODS: We searched major web databases for randomized controlled trials of CRT in patients with mild heart failure (NYHA functional class I-II). Data regarding all-cause mortality, heart failure events, left ventricular (LV) volumes and ejection fraction, and worsening of NYHA functional class were extracted. RESULTS: We identified five trials (CONTAK-CD, MIRACLE ICD-II, REVERSE, MADIT-CRT, and RAFT) that enrolled 4,213 patients (91% with NYHA II functional class). Primary analysis excluded the CONTAK-CD, which was not specifically conducted on patients with mild heart failure. At pooled analysis, CRT decreased mortality (odds ratio (OR), 0.78 [95% confidence interval (CI)], 0.63 to 0.97; p = 0.024) and heart failure events (OR, 0.63 [95% CI, 0.52 to 0.76], p < 0.001), induced a significant LV reverse remodeling (weighted mean difference (WMD) of LV ejection fraction [Formula: see text], p = 0.015 and WMD of LV end-systolic volume index [Formula: see text], p < 0.001) and prevented the progression of heart failure symptoms (OR for worsening of NYHA functional class = 0.54 [95% CI, 0.31 to 0.93], p = 0.026). Inclusion of the CONTAK-CD did not change the results. CONCLUSIONS: Among patients with mild (NYHA II) heart failure, CRT reduces mortality and the risk of heart failure events, induces a favorable LV reverse remodeling and slows the progression of heart failure symptoms.
Authors:
Pasquale Santangeli; Luigi Di Biase; Gemma Pelargonio; Antonio Dello Russo; Michela Casella; Stefano Bartoletti; J David Burkhardt; Prasant Mohanty; Pietro Santarelli; Andrea Natale
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-19
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  -     ISSN:  1572-8595     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 1015 East 32nd Street, Suite 408, Austin, TX, USA, pasquale.santangeli@libero.it.
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