| Effects of cardiac resynchronization therapy in patients unselected for mechanical dyssynchrony. | |
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MedLine Citation:
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PMID: 19246108 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Observational echocardiographic studies have suggested that pre-implant dyssynchrony is required for a response to cardiac resynchronization therapy. Some clinical guidelines on CRT have adopted dyssynchrony as a requirement prior to CRT. AIMS: To assess the effects of CRT in patients with heart failure who are unselected for mechanical dyssynchrony. METHODS: 248 consecutive patients with heart failure (sinus rhythm, NYHA class III [n=171, 89%]) or IV (n=77, 31%; LVEF<or=35%, QRS>or=120 ms) underwent a clinical assessment, including NYHA class, 6-min walking distance and quality of life (Minnesota Living with Heart Failure questionnaire) before and after CRT. Clinical event variables included mortality and hospitalizations for major cardiovascular events and for heart failure. RESULTS: At follow-up, NYHA class was reduced from 3.25+/-0.56 to 2.06+/-0.84 (mean+/-SD, p<0.0001). There were also improvements in 6-min walking distance (232.2+/-113.8 to 302.9+/-119.5 m) and quality of life scores (56.1+/-20.4 to 32.5+/-23.4) (both p<0.0001). Responder rate, defined as improvement by >or=1 NYHA classes or>or=25% in 6-min walking distance, was 81% (202/248 patients). Over a follow-up period of up to 7.4 years (median 720 days), the annualized total and cardiovascular mortality rates were 11.7% and 9.89%, respectively. CONCLUSIONS: In patients undergoing CRT, the improvements in functional capacity and quality of life as well as the event rates expected from landmark trials are achievable by selecting patients on the basis of NYHA class, LVEF and QRS duration alone. The added value of echocardiographic measures of dyssynchrony remains questionable. |
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Authors:
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Paul W X Foley; Shajil Chalil; Kayvan Khadjooi; Paul Jordan; Russell E A Smith; Michael P Frenneaux; Francisco Leyva |
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Publication Detail:
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Type: Journal Article Date: 2009-02-25 |
Journal Detail:
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Title: International journal of cardiology Volume: 143 ISSN: 1874-1754 ISO Abbreviation: Int. J. Cardiol. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-19 Completed Date: 2010-10-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8200291 Medline TA: Int J Cardiol Country: Netherlands |
Other Details:
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Languages: eng Pagination: 51-6 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved. |
Affiliation:
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University of Birmingham, Department of Cardiology, Good Hope Hospital, Sutton Coldfield, United Kingdom. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Pacing, Artificial / statistics & numerical data* Female Follow-Up Studies Heart Failure* / mortality, physiopathology, therapy Hospitalization / statistics & numerical data* Humans Kaplan-Meiers Estimate Male Middle Aged Quality of Life Recovery of Function Treatment Outcome Walking |
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