Benefits of cardiac resynchronization therapy in outpatients with indicators for heart transplantation.
BACKGROUND
Despite several new advances in the treatment of end-stage congestive heart failure (CHF) the number of patients moving onto the heart transplant list continues to rise. Recently, cardiac resynchronization therapy (CRT) has become a Food and Drug Administration (FDA)-approved therapy for advanced CHF. Currently, there are no available data on CRT in cardiac transplant candidates.


METHODS
To determine the effects of CRT on potential transplant candidates we retrospectively reviewed patients (n = 34) enrolled in resynchronization trials at our center who met accepted criteria for transplantation. Ventricular function, oxygen uptake and New York Heart Association (NYHA) class were compared at baseline and after 6 months of active therapy for each patient.


RESULTS
CRT reduced QRS duration from 178 +/- 29 to 143 +/- 17 msec (p < 0.0001) and NYHA class from 3.1 +/- 0.3 to 1.8 +/- 0.7 (p < 0.0001). Ejection fraction (EF) increased from 18.4 +/- 5.1 to 25.1 +/- 8.4% (p < 0.0001) and maximum VO(2) increased from 11.9 +/- 1.8 to 15.3 +/- 3 ml/kg/min (p < 0.0001). Only 2 of the initial 34 patients still met the criteria for transplantation at 6 months.


CONCLUSIONS
CRT improves ventricular function, oxygen uptake and NYHA class in ambulatory patients who have a QRS of >130 msec and might be considered candidates for cardiac transplantation. Transplantation can be prevented or deferred in the majority of patients. Outpatients with chronic CHF and a widened QRS should be evaluated for CRT before being listed for cardiac transplantation.
Greenberg
Jeffrey M
JM
Center for Heart Failure Therapy, Emory University School of Medicine, 1364 Clifton Road NE, Suite 508, Atlanta, GA 30322, USA.
Leon
Angel R
AR
Book
Wendy M
WM
Hott
Brenda J
BJ
DeLurgio
David B
DB
Langberg
Jonathan J
JJ
Smith
Andrew L
AL
D002304:Cardiac Pacing, Artificial / Q000379:methods; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000628:therapy