Effects of cardiac resynchronization therapy in patients unselected for mechanical dyssynchrony.
BACKGROUND
Observational echocardiographic studies have suggested that pre-implant dyssynchrony is required for a response to cardiac resynchronization therapy. Some clinical guidelines on CRT have adopted dyssynchrony as a requirement prior to CRT.


OBJECTIVE
To assess the effects of CRT in patients with heart failure who are unselected for mechanical dyssynchrony.


METHODS
248 consecutive patients with heart failure (sinus rhythm, NYHA class III [n=171, 89%]) or IV (n=77, 31%; LVEF<or=35%, QRS>or=120 ms) underwent a clinical assessment, including NYHA class, 6-min walking distance and quality of life (Minnesota Living with Heart Failure questionnaire) before and after CRT. Clinical event variables included mortality and hospitalizations for major cardiovascular events and for heart failure.


RESULTS
At follow-up, NYHA class was reduced from 3.25+/-0.56 to 2.06+/-0.84 (mean+/-SD, p<0.0001). There were also improvements in 6-min walking distance (232.2+/-113.8 to 302.9+/-119.5 m) and quality of life scores (56.1+/-20.4 to 32.5+/-23.4) (both p<0.0001). Responder rate, defined as improvement by >or=1 NYHA classes or>or=25% in 6-min walking distance, was 81% (202/248 patients). Over a follow-up period of up to 7.4 years (median 720 days), the annualized total and cardiovascular mortality rates were 11.7% and 9.89%, respectively.


CONCLUSIONS
In patients undergoing CRT, the improvements in functional capacity and quality of life as well as the event rates expected from landmark trials are achievable by selecting patients on the basis of NYHA class, LVEF and QRS duration alone. The added value of echocardiographic measures of dyssynchrony remains questionable.
Foley
Paul W X
PW
University of Birmingham, Department of Cardiology, Good Hope Hospital, Sutton Coldfield, United Kingdom.
Chalil
Shajil
S
Khadjooi
Kayvan
K
Jordan
Paul
P
Smith
Russell E A
RE
Frenneaux
Michael P
MP
Leyva
Francisco
F
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D016896:Treatment Outcome; D016138:Walking