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Long Term Effects of Cardiac Resynchronization Therapy in Non-Ambulatory NYHA IV Heart Failure Patients.
MedLine Citation:
PMID:  21913946     Owner:  NLM     Status:  Publisher    
Background: We aimed at evaluating the long-term effects of cardiac resynchronization therapy (CRT) in nonambulatory New York Heart Association (NYHA) IV heart failure patients (NAIVHFP). Methods: Eighteen patients, 15 men and three women, eight with ischemic and 10 with nonischemic cardiomyopathy, who underwent biventricular pacemaker implantation while they were in nonambulatory NYHA IV class, were studied. Patients' age was 58 ± 9 years and left ventricular ejection fraction (LVEF) 18 ± 3 %. Follow-up data were obtained through review of follow-up visits notes, stored echocardiographic studies, device interrogation data, and death certificates. Results: After a mean duration of 1223 ± 846 days, 11 patients were alive, including five patients who underwent heart transplantation (OCT) and seven dead. Three of 11 patients who received a CRT-defibrillator, experienced at least one appropriate discharge, but eventually they either died or received an OCT during follow-up. Sustained improvements in NYHA class (Z = 2.4, P = 0.015) and 6-minute walk distance (0 vs 212 ± 95 m, P ≪ 0.001) were documented after a median duration of 855 days postimplantation. Cumulative proportion of death or OCT at 18 months-when full follow-up data were available-was 18%, which compared favorably with historical controls. Full echocardiographic and clinical follow-up data at 12-months postimplantation were available for 10 patients, documenting a significant reduction in end-systolic volume (248 ± 82 vs 269 ± 97 mL, P = 0.039). Conclusions: CRT can be safely applied in this subset of extreme severity heart failure patients, achieving encouraging survival rates and reverse remodeling effects. These observations can form an evidence-based rationale for including NAIVHFP in randomized CRT trials. (PACE 2011;1-8).
George Theodorakis; Athanasios Katsikis; Efthimios Livanis; Anna Kostopoulou; Stamatis Adamopoulos; Dimitrios Tsiapras; Vassilis Voudris
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-13
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  -     ISSN:  1540-8159     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.
Onassis Cardiac Surgery Center, Athens, Greece Henry Dynant Hospital, Athens, Greece.
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