title: Quality of life in cardiac resynchronization recipients: association with response and impact on outcome.
abstract: BACKGROUND
  The prognostic impact of improvement in health-related quality of life (QoL) and its relation to response in cardiac resynchronization therapy (CRT) recipients remains unknown.
  
  
  OBJECTIVE
  To assess the correspondence between response to CRT and improvements in QoL and to verify if a change in QoL after pacing influences outcome in CRT patients.
  
  
  METHODS
  Ninety-seven participants of the Triple-Site Versus Standard Cardiac Resynchronization Therapy Trial (TRUST CRT) randomized trial, in New York Heart Association class III-IV, QRS width ≥ 120 ms, left ventricular ejection fraction ≤ 35%, and significant mechanical dyssynchrony were included. Subjects filled out the Minnesota-QoL questionnaire prior to and 6 months after CRT with defibrillator (CRT-D) implantation. Data on major adverse cardiac events (MACEs: death, heart failure hospitalization, heart transplant) collected within the next 2.5 years and adjudicated blindly constituted the censoring variables.
  
  
  RESULTS
  Within the first 6 months of resynchronization QoL improved in 81%, while worsening in 19% of patients. Clinical response, but not the echocardiographic one, was associated with improved QoL. During subsequent 2.5 years MACEs occurred in 37% of patients (23% died). Subjects without QoL improvement were significantly (both P < 0.05) more prone to experience MACE (61% vs 32%) and die (44% vs 18%) within the follow-up. Unimproved QoL increased the probability of future MACE by 2.7 times (95% confidence intervals [CI]: 1.26-5.83; P = 0.01) and death by 3.2 times (95% CI: 1.23-8.32; P = 0.02) independently from clinical and echocardiographic response.
  
  
  CONCLUSIONS
  Clinical response, but not the echocardiographic one, was associated with improved QoL in CRT recipients. These preliminary data suggest that lack of improvement in QoL after CRT was associated with a strongly unfavorable prognosis, regardless of functional or echocardiographic response. Our results merit further studies with a larger number of patients.
authors.affiliation: From the Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Lenarczyk
authors.forename: Ewa
authors.initials: E
authors.lastname: Jędrzejczyk-Patej
authors.forename: Michał
authors.initials: M
authors.lastname: Mazurek
authors.forename: Mariola
authors.initials: M
authors.lastname: Szulik
authors.forename: Oskar
authors.initials: O
authors.lastname: Kowalski
authors.forename: Patrycja
authors.initials: P
authors.lastname: Pruszkowska
authors.forename: Adam
authors.initials: A
authors.lastname: Sokal
authors.forename: Beata
authors.initials: B
authors.lastname: Średniawa
authors.forename: Joanna
authors.initials: J
authors.lastname: Boidol
authors.forename: Jacek
authors.initials: J
authors.lastname: Kowalczyk
authors.forename: Tomasz
authors.initials: T
authors.lastname: Podolecki
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Mencel
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
mesh_terms: D058406:Cardiac Resynchronization Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: cardiac resynchronization therapy; heart failure; pacing; prognosis; quality of life