Long-term follow-up of cardiac resynchronization therapy in patients with end-stage heart failure.
Long-term follow-up of cardiac resynchronization therapy.


BACKGROUND
Cardiac resynchronization therapy (CRT) has been introduced to treat patients with end-stage heart failure, and results of this technique are promising. The aim of our study was to assess the sustained benefit of CRT in a large patient cohort with end-stage heart failure at long-term follow-up. In addition, the prognosis of responders and nonresponders was evaluated.


RESULTS
125 patients with end-stage heart failure, NYHA class III or IV, LVEF<35%, QRS duration>120 msec and left bundle branch block morphology received a biventricular device. At baseline and 6 months after implantation the following parameters were evaluated: NYHA class, Minnesota Quality of life score, QRS duration on surface ECG, 6-minute walking distance and LVEF. Follow-up was obtained up to 3 years. After 6 months, patients were divided in clinical responders and nonresponders according to improvement in NYHA class. All clinical parameters improved significantly at 6-month follow-up. Hospitalization for heart failure was 3.8+/-4.9 days/year before and 0.7+/-1.6 days/year after CRT. Survival at 1-, 2-, and 3-year follow-up was 93%, 88%, and 85%, respectively. Responders (78%) showed a significantly better survival than nonresponders at 2- and 3-year follow-up (96% and 93% for responders versus 81% and 73% for nonresponders, P<0.05).


CONCLUSIONS
The improvement in functional status and symptoms after CRT is maintained at long-term follow-up (up to 3 years). The clinical improvement was associated with a significant reduction in hospitalization rate which was also maintained over the years. Preimplantation selection of responders may result in even better long-term survival.
Molhoek
Sander G
SG
Department of Cardiology, Leiden University Medical Center, The Netherlands.
Bax
Jeroen J
JJ
Bleeker
Gabe B
GB
Holman
Eduard R
ER
Van Erven
Lieselot
L
Bootsma
Marianne
M
Boersma
Eric
E
Steendijk
Paul
P
Van Der Wall
Ernst E
EE
Schalij
Martin J
MJ
D000368:Aged; D002303:Cardiac Output, Low / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000592:standards; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome