Document Detail


The effect of cardiac resynchronization on morbidity and mortality in heart failure.
MedLine Citation:
PMID:  15753115     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We evaluated its effects on morbidity and mortality. METHODS: Patients with New York Heart Association class III or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony who were receiving standard pharmacologic therapy were randomly assigned to receive medical therapy alone or with cardiac resynchronization. The primary end point was the time to death from any cause or an unplanned hospitalization for a major cardiovascular event. The principal secondary end point was death from any cause. RESULTS: A total of 813 patients were enrolled and followed for a mean of 29.4 months. The primary end point was reached by 159 patients in the cardiac-resynchronization group, as compared with 224 patients in the medical-therapy group (39 percent vs. 55 percent; hazard ratio, 0.63; 95 percent confidence interval, 0.51 to 0.77; P<0.001). There were 82 deaths in the cardiac-resynchronization group, as compared with 120 in the medical-therapy group (20 percent vs. 30 percent; hazard ratio 0.64; 95 percent confidence interval, 0.48 to 0.85; P<0.002). As compared with medical therapy, cardiac resynchronization reduced the interventricular mechanical delay, the end-systolic volume index, and the area of the mitral regurgitant jet; increased the left ventricular ejection fraction; and improved symptoms and the quality of life (P<0.01 for all comparisons). CONCLUSIONS: In patients with heart failure and cardiac dyssynchrony, cardiac resynchronization improves symptoms and the quality of life and reduces complications and the risk of death. These benefits are in addition to those afforded by standard pharmacologic therapy. The implantation of a cardiac-resynchronization device should routinely be considered in such patients.
Authors:
John G F Cleland; Jean-Claude Daubert; Erland Erdmann; Nick Freemantle; Daniel Gras; Lukas Kappenberger; Luigi Tavazzi;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2005-03-07
Journal Detail:
Title:  The New England journal of medicine     Volume:  352     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-04-14     Completed Date:  2005-04-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1539-49     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2005 Massachusetts Medical Society.
Affiliation:
Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom. j.g.cleland@hull.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Pacing, Artificial* / methods
Combined Modality Therapy
Female
Follow-Up Studies
Heart Failure / complications,  mortality,  physiopathology,  therapy*
Hospitalization
Humans
Male
Middle Aged
Myocardial Contraction
Pacemaker, Artificial* / adverse effects
Stroke Volume
Survival Analysis
Ventricular Dysfunction, Left / complications,  therapy
Comments/Corrections
Comment In:
N Engl J Med. 2005 Jul 14;353(2):205-6; author reply 205-6   [PMID:  16021697 ]
N Engl J Med. 2005 Jul 14;353(2):205-6; author reply 205-6   [PMID:  16014892 ]
ACP J Club. 2005 Sep-Oct;143(2):29   [PMID:  16134903 ]
N Engl J Med. 2005 Apr 14;352(15):1594-7   [PMID:  15829542 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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