Effectiveness of cardiac resynchronization therapy in heart failure patients with valvular heart disease: comparison with patients affected by ischaemic heart disease or dilated cardiomyopathy. The InSync/InSync ICD Italian Registry.
OBJECTIVE
To analyse the effectiveness of cardiac resynchronization therapy (CRT) in patients with valvular heart disease (a subset not specifically investigated in randomized controlled trials) in comparison with ischaemic heart disease or dilated cardiomyopathy patients.


RESULTS
Patients enrolled in a national registry were evaluated during a median follow-up of 16 months after CRT implant. Patients with valvular heart disease treated with CRT (n = 108) in comparison with ischaemic heart disease (n = 737) and dilated cardiomyopathy (n = 635) patients presented: (i) a higher prevalence of chronic atrial fibrillation, with atrioventricular node ablation performed in around half of the cases; (ii) a similar clinical and echocardiographic profile at baseline; (iii) a similar improvement of LVEF and a similar reduction in ventricular volumes at 6-12 months; (iv) a favourable clinical response at 12 months with an improvement of the clinical composite score similar to that occurring in patients with dilated cardiomyopathy and more pronounced than that observed in patients with ischaemic heart disease; (v) a long-term outcome, in term of freedom from death or heart transplantation, similar to patients affected by ischaemic heart disease and basically more severe than that of patients affected by dilated cardiomyopathy.


CONCLUSIONS
In 'real world' clinical practice, CRT appears to be effective also in patients with valvular heart disease. However, in this group of patients the outcome after CRT does not precisely overlap any of the two other groups of patients, for which much more data are currently available.
Boriani
Giuseppe
G
Institute of Cardiology, University of Bologna, Azienda Ospedaliera S.Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. giuseppe.boriani@unibo.it
Gasparini
Maurizio
M
Landolina
Maurizio
M
Lunati
Maurizio
M
Biffi
Mauro
M
Santini
Massimo
M
Padeletti
Luigi
L
Molon
Giulio
G
Botto
Gianluca
G
De Santo
Tiziana
T
Valsecchi
Sergio
S
D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery; D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000628:therapy*; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006349:Heart Valve Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy*; D010138:Pacemaker, Artificial; D012042:Registries; D016896:Treatment Outcome; D020257:Ventricular Remodeling