title: Time from emerging heart failure symptoms to cardiac resynchronisation therapy: impact on clinical response.
abstract: OBJECTIVE
  To investigate whether time from onset of heart failure signs and/or symptoms (ie, progression to stage C/D heart failure) until implantation affects reverse remodelling and clinical outcome after cardiac resynchronisation therapy (CRT).
  
  
  METHODS
  Cohort study of consecutive CRT patients, implanted between 1 October 2008 and 30 April 2011.
  
  
  METHODS
  Single tertiary care centre (Ziekenhuis Oost-Limburg, Genk, Belgium).
  
  
  METHODS
  Consecutive CRT patients (n=172; 71±9 years), stratified into tertiles according to the time since first heart failure signs and/or symptoms at implantation.
  
  
  METHODS
  Change in left ventricular dimensions, New York Heart Association (NYHA) functional class and freedom from all-cause mortality or heart failure admission.
  
  
  RESULTS
  Baseline renal function was better in patients implanted earlier after emerging heart failure symptoms (estimated glomerular filtration rate=73±20 vs 63±23 vs 58±26 ml/min/1.73 m(2) for tertiles, respectively). After 6 months, decreases in left ventricular end-diastolic/systolic diameter and improvement in NYHA functional class were similar among tertiles. Freedom from all-cause mortality or heart failure admission was better in patients with early implantation (p value=0.042). However, this was not the case in patients with preserved renal function (p value=0.794). Death from progressive heart failure was significantly more frequent in patients implanted later in their disease course.
  
  
  CONCLUSIONS
  Reverse left ventricular remodelling after CRT is not affected by the duration of heart failure. However, clinical outcome is better in patients implanted earlier in their disease course, which probably relates to better renal preservation.
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium.
authors.forename: Frederik Hendrik
authors.initials: FH
authors.lastname: Verbrugge
authors.forename: Matthias
authors.initials: M
authors.lastname: Dupont
authors.forename: Jan
authors.initials: J
authors.lastname: Vercammen
authors.forename: Linda
authors.initials: L
authors.lastname: Jacobs
authors.forename: David
authors.initials: D
authors.lastname: Verhaert
authors.forename: Pieter
authors.initials: P
authors.lastname: Vandervoort
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mullens
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*