The effectiveness of cardiac resynchronization therapy for patients with New York Heart Association class IV non-ambulatory heart failure.
BACKGROUND
We reviewed the effectiveness and safety of cardiac resynchronization therapy (CRT) for patients with New York Heart Association (NYHA) class IV non-ambulatory heart failure (NAHF).


METHODS
From 2006 to 2011, 310 patients underwent CRT at Kobe University Hospital and Himeji Cardiovascular Center because of heart failure. Of these, 29 NAHF patients were retrospectively analyzed. The control group comprised 21 age- and ejection fraction-matched patients with NAHF who did not undergo CRT from the ICU database of Kobe University Hospital. The primary endpoint was all-cause death and hospitalization for heart failure. Response was defined as a >15% reduction in left ventricular end-systolic volume (LVESV).


RESULTS
CRT was performed successfully without serious complications in all patients. Twenty-three patients (79%) were discharged 19±15 days after CRT implantation, while 6 (21%) died during their hospital stay due to progressive heart failure. Compared with the control group, patients in the CRT group showed significant improvements in the primary endpoint (log-rank p=0.04). Six patients (21%) were defined as responders and the Kaplan-Meier curve showed that responders experienced a better outcome than non-responders (log-rank p=0.029). LV dyssynchrony before implantation was significantly related to the occurrence of the primary endpoint (p=0.02).


CONCLUSIONS
CRT can be safely used in patients with NAHF and can improve long-term patient outcomes, especially in treatment responders.
Section of Arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chu-ou-ku, Kobe, Japan.
Soichiro
S
Yamashita
Section of Arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chu-ou-ku, Kobe, Japan ; Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Koji
K
Fukuzawa
Section of Arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chu-ou-ku, Kobe, Japan ; Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Akihiro
A
Yoshida
Section of Arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chu-ou-ku, Kobe, Japan.
Mitsuaki
M
Itoh
Section of Arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chu-ou-ku, Kobe, Japan.
Kimitake
K
Imamura
Section of Arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chu-ou-ku, Kobe, Japan.
Ryudo
R
Fujiwara
Section of Arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chu-ou-ku, Kobe, Japan.
Atsushi
A
Suzuki
Section of Arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chu-ou-ku, Kobe, Japan.
Tomoyuki
T
Nakanishi
Section of Arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chu-ou-ku, Kobe, Japan.
Akinori
A
Matsumoto
Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan.
Gaku
G
Kanda
Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan.
Kunihiko
K
Kiuchi
Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan.
Akira
A
Shimane
Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan.
Katsunori
K
Okajima
Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Hidekazu
H
Tanaka
Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Ken-Ichi
K
Hirata
Cardiac resynchronization therapy; Heart failure; NYHA IV; Radial strain dyssynchrony