Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for an implantable cardioverter-defibrillator, and mildly symptomatic chronic heart failure.
BACKGROUND
The effects of cardiac resynchronization therapy (CRT) in patients with mildly symptomatic heart failure have not been fully elucidated.


RESULTS
The Multicenter InSync ICD Randomized Clinical Evaluation II (MIRACLE ICD II) was a randomized, double-blind, parallel-controlled clinical trial of CRT in NYHA class II heart failure patients on optimal medical therapy with a left ventricular (LV) ejection fraction < or =35%, a QRS > or =130 ms, and a class I indication for an ICD. One hundred eighty-six patients were randomized: 101 to the control group (ICD activated, CRT off) and 85 to the CRT group (ICD activated, CRT on). End points included peak VO2, VE/CO2, NYHA class, quality of life, 6-minute walk distance, LV volumes and ejection fraction, and composite clinical response. Compared with the control group at 6 months, no significant improvement was noted in peak VO2, yet there were significant improvements in ventricular remodeling indexes, specifically LV diastolic and systolic volumes (P=0.04 and P=0.01, respectively), and LV ejection fraction (P=0.02). CRT patients showed statistically significant improvement in VE/CO2 (P=0.01), NYHA class (P=0.05), and clinical composite response (P=0.01). No significant differences were noted in 6-minute walk distance or quality of life scores.


CONCLUSIONS
In patients with mild heart failure symptoms on optimal medical therapy with a wide QRS complex and an ICD indication, CRT did not alter exercise capacity but did result in significant improvement in cardiac structure and function and composite clinical response over 6 months.
Abraham
William T
WT
Ohio State University Heart Center, Division of Cardiovascular Medicine, 473 W 12th Ave, Room 110P DHLRI, Columbus, OH 43210-1252. abraham-1@medctr.osu.edu.
Young
James B
JB
León
Angel R
AR
Adler
Stuart
S
Bank
Alan J
AJ
Hall
Shelley A
SA
Lieberman
Randy
R
Liem
L Bing
LB
O'Connell
John B
JB
Schroeder
John S
JS
Wheelan
Kevin R
KR
D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017147:Defibrillators, Implantable; D018450:Disease Progression; D004311:Double-Blind Method; D004554:Electric Countershock; D004562:Electrocardiography; D005080:Exercise Test; D017079:Exercise Tolerance; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000517:prevention & control; D020257:Ventricular Remodeling
D002317:Cardiovascular Agents