title: Clinical benefit of cardiac resynchronization therapy with a defibrillator in patients with an ejection fraction > 35% estimated by cardiac magnetic resonance.
abstract: OBJECTIVE
  Cardiac resynchronization therapy with a defibrillator prolongs survival and improves quality of life in advanced heart failure. Traditionally, patients with ejection fraction > 35 estimated by echocardiography have been excluded. We assessed the prognostic impact of this therapy in a group of patients with severely depressed systolic function as assessed by echocardiography but with an ejection fraction > 35% as assessed by cardiac magnetic resonance.
  
  
  METHODS
  We analyzed consecutive patients admitted for decompensated heart failure between 2004 and 2011. The patients were in functional class II-IV, with a QRS ≥ to 120 ms, ejection fraction ≤ 35% estimated by echocardiography, and a cardiac magnetic resonance study. We included all patients (n=103) who underwent device implantation for primary prevention. Ventricular arrhythmia, all-cause mortality and readmission for heart failure were considered major cardiac events. The patients were divided into 2 groups according to systolic function assessed by magnetic resonance.
  
  
  RESULTS
  The 2 groups showed similar improvements in functional class and ejection fraction at 6 months. We found a nonsignificant trend toward a higher risk of all-cause mortality in patients with systolic function ≤ 35% at long-term follow-up. The presence of a pattern of necrosis identified patients with a worse prognosis for ventricular arrhythmias and mortality in both groups.
  
  
  CONCLUSIONS
  We conclude that cardiac resynchronization therapy with a defibrillator leads to a similar clinical benefit in patients with an ejection fraction ≤ 35% or > 35% estimated by cardiac magnetic resonance. Analysis of the pattern of late gadolinium enhancement provides additional information on arrhythmic risk and long-term prognosis.
authors.affiliation: Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España. Electronic address: haskarande@gmail.com.
authors.forename: Oscar
authors.initials: O
authors.lastname: Fabregat-Andrés
authors.affiliation: Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: García-González
authors.affiliation: Servicio de Cardiología, Hospital Marina Salud, Denia, Valencia, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Valle-Muñoz
authors.affiliation: Unidad de Imagen Cardiaca, ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Estornell-Erill
authors.affiliation: Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Leandro
authors.initials: L
authors.lastname: Pérez-Boscá
authors.affiliation: Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Victor
authors.initials: V
authors.lastname: Palanca-Gil
authors.affiliation: Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España; Departamento de Medicina, Facultad de Medicina, Universitat de València, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Payá-Serrano
authors.affiliation: Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Quesada-Dorador
authors.affiliation: Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Salvador
authors.initials: S
authors.lastname: Morell
authors.affiliation: Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España; Departamento de Medicina, Facultad de Medicina, Universitat de València, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ridocci-Soriano
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000517:prevention & control; D014693:Ventricular Fibrillation / Q000517:prevention & control
keywords: Cardiac magnetic resonance; Cardiac resynchronization therapy; Desfibrilador automático implantable; Disfunción moderada; Implantable cardioverter defibrillator; Late gadolinium enhancement; Mild systolic dysfunction; Realce tardío de gadolinio; Resonancia magnética cardiaca; Terapia de resincronización cardiaca