title: Relationship between pre-implant ejection fraction and outcome after cardiac resynchronization therapy in symptomatic patients.
abstract: BACKGROUND
  Left-ventricular ejection fraction (LVEF) is regarded as a strong predictor for morbidity and mortality in heart failure patients. The aim of the analysis was to assess the relationship between pre-implant LVEF and outcome of patients with advanced heart failure who received cardiac resynchronization therapy (CRT).
  
  
  METHODS
  We analysed the two-year follow-up of 366 patients who had been enrolled in the MASCOT study which included NYHA class III/IV patients with a class I CRT indication. Pre-implant LVEF was stratified by tertile.
  
  
  RESULTS
  The boundaries for pre-implant LVEF were < 22% (n = 128; 18.2 +/- 3.1%; T(low)), 22% to 28% (n = 121; 25.4 +/- 1.4%; T(middle)) and > 28% (n = 117; 32.6 +/- 3.9%; T(high)) for each tertile.Two-year post-implant LVEF was 32.0 +/- 11.5% (T(low)), 33.7 +/- 10.8% (T(middle)) and 36.4 +/- 9.9% (T(high)). T(Iow) had a greater increase between pre- and post-implant LVEF compared to T(middle) (P = 0.03) and T(high) (P = 0.0001). NYHA class improved similarly among the three groups as well as the quality of life score. No significant differences were detected between the three groups for all-cause mortality, cardiac death, all-cause hospitalization, and hospitalization due to worsening heart failure.
  
  
  CONCLUSIONS
  Symptomatic heart failure patients with a wide QRS complex and a severe impaired LV function had a better improvement of their pre-implant LVEF than patients with a more preserved LVEF. This may be one reason that in these patient groups long-term morbidity and mortality were not related to their pre-implant LVEF. Pre-implant LVEF was in symptomatic CRT patients not predictive for their long-term cardiovascular morbidity and mortality.
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: 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; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005858:Germany; D006115:Greece; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016037:Single-Blind Method; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography