title: One-year outcome after CRT implantation in NYHA class IV in comparison to NYHA class III patients.
abstract: BACKGROUND
  The aim of the analysis was to compare the outcome of heart failure patients in New York Heart Association (NYHA) class IV to that of NYHA class III patients 1 year after implantation of a CRT device.
  
  
  METHODS
  The analysis was based on the 405 CRT patients enrolled in the MASCOT trial. At enrollment, 350 patients (86%) were in NYHA class III and 55 (14 %) were in NYHA class IV.
  
  
  RESULTS
  At 1-year follow-up, the improvement of the ejection fraction was not statistically significantly different between NYHA class III (+7.6 ± 11.7%) and NYHA class IV patients (+9.2 ± 14.2 %; p = 0.78). NYHA class IV patients had a better mean NYHA class reduction with -1.93 ± 0.83 than NYHA class III patients with -0.93 ± 0.70 (p < 0.0001). There was a greater mean quality of life improvement in NYHA class IV (-27.2 ± 20.9) compared to NYHA class III (-17.7 ± 23.9; p = 0.02). All-cause mortality as well as cardiac mortality remained higher in NYHA class IV with 25.5 and 16.4% than in NYHA class III with 7.1 and 3.1% (p < 0.0001).
  
  
  CONCLUSIONS
  In this study, 14% of all patients receiving a CRT device had NYHA class IV at implantation. The data support the concept to implant a CRT device in NYHA class IV patients, because at 1 year after implantation, they experienced better symptomatic improvement compared to NYHA class III patients. The higher cardiac as well as non-cardiac mortality resulted in a fivefold higher all-cause mortality compared to NYHA class III patients.
authors.affiliation: Friedrich-Ebert Hospital, Medical Clinic, Friesenstr. 11, 24531 Neumünster, Germany. andreas.schuchert@fek.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuchert
authors.forename: Carmine
authors.initials: C
authors.lastname: Muto
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Maounis
authors.forename: Robert
authors.initials: R
authors.lastname: Frank
authors.forename: Rita Omega
authors.initials: RO
authors.lastname: Ella
authors.forename: Alexander
authors.initials: A
authors.lastname: Polauck
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
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