Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure

Bristow, Michael R.; Saxon, LA Leslie A; Boehmer, John; Krueger, Steven K.; Kass, David A.; Marco, Teresa De; Carson, Peter E.; DiCarlo, Lorenzo A.; DeMets, David L.; White, Bill G.; DeVries, Dale W; Feldman, Arthur M.

doi:10.1056/nejmoa032423

Cited by 5,180 publications

(3,163 citation statements)

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“…This benefit has been observed in patients with mild‐to‐severe HF symptoms in randomized studies 1, 2, 3, 4, 5, 6. The European Society of Cardiology Guidelines for clinical practice of HF7 recommend ACEIs and BBs as an initial step in symptomatic HF, and both of these treatments have been shown to reduce mortality and HF hospitalizations (Class of Recommendation I, Level of Evidence A).…”

Section: Discussionmentioning

confidence: 98%

“…Major clinical trials have demonstrated the benefit of cardiac resynchronization therapy (CRT) with a defibrillator (CRT‐D) or pacemaker (CRT‐P) in terms of clinical outcomes, HF and/or mortality in patients with mild‐to‐severe symptomatic HF with prolonged QRS width and left ventricular ejection fraction (LVEF) <35% under OMT. CRT has been shown to reduce mortality, morbidity, and improve quality of life in these patients with a life expectancy exceeding 1 year 1, 2, 3, 4, 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

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Cardiac resynchronization therapy outcomes in patients under nonoptimal medical therapy

Álvarez‐Álvarez

García‐Seara

Martínez‐Sande

et al. 2018

Journal of Arrhythmia

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BackgroundCardiac resynchronization therapy (CRT) is indicated in symptomatic heart failure (HF) patients after achieving optimal medical therapy (OMT). However, many patients may not be under OMT when the CRT device is implanted. Here, we evaluate the long‐term benefits of CRT in symptomatic HF patients receiving or not OMT.MethodsWe investigated the effect of OMT on HF developing or death in 328 consecutive patients with a CRT device implanted between 2005 and 2015 in a single tertiary center. After the CRT implant, we categorized the patients into three groups: no OMT, OMT at baseline and after 1 year of follow‐up, and OMT only at the 1‐year follow‐up but not at baseline. We used multivariate Cox proportional hazards model to determine the effect of OMT on clinical outcomes.ResultsOne hundred and twenty‐two patients (37.2%) received OMT prior to CRT. OMT at baseline was not associated with a reduced risk of death or HF (HR 0.72; 95% CI 0.50‐1.02; P = 0.067) compared with no‐basal‐OMT patients. After CRT, patients without OMT had a higher risk of death or HF than patients who received OMT in follow‐up (HR 1.72, 95% CI 1.07‐2.78, P = 0.025), and the risk of the patients who received OMT at baseline and at the 1‐year follow‐up was similar to that of the patients who achieved OMT at the 1‐year follow‐up (HR 0.90, 95% CI 0.54‐1.50, P = 0.682).ConclusionBasal OMT prior to CRT is not associated with better outcomes in terms of HF/death compared with no basal OMT. The subgroup of patients who achieved OMT at the 1‐year follow‐up exhibited a reduced risk of HF and death compared with patients who did not.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Cardiac resynchronization therapy outcomes in patients under nonoptimal medical therapy

Álvarez‐Álvarez

García‐Seara

Martínez‐Sande

et al. 2018

Journal of Arrhythmia

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“…Most of the patients receiving CRT can also be a candidate of ICD, and once CRT‐D was launched, CRT‐D has been mainly used instead of CRT pacemaker. COMPANION study4 published in 2004 randomized patients with NYHA class III or IV, QRS width ≥120 ms, and EF ≤35% into three groups; pharmacotherapy, CRT, and CRT‐D. This study showed that CRT and CRT‐D decreased all‐cause mortality and rehospitalization for HF compared with pharmacotherapy.…”

Section: Improvement Of Survival As Well As Qolmentioning

confidence: 99%

“…The benefit of CRT has been reported in many clinical studies that it can improve the prognosis of the HF patients as well as the quality of life (QOL) 3, 4. It is also important to prevent sudden cardiac death due to lethal arrhythmias in HF patients, and CRT with defibrillators (CRT‐D) has been applied in most cases.…”

Section: Introductionmentioning

confidence: 99%

Up‐to‐date cardiac resynchronization therapy

Okamura

2017

J of Gen and Family Med

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Cardiac resynchronization therapy (CRT) has been first reported more than 10 years ago as a therapy for patients with severe chronic heart failure. The efficacy of CRT has been proven in many studies that it improves not only quality of life but also the prognosis of the patients. Its indication has been expanded for patients with mild heart failure. On the other hand, some patients cannot receive enough benefit through CRT. The position of the left ventricular lead is limited due to the anatomy of coronary sinus branches, pacing threshold of the myocardium, phrenic nerve stimulation, and so on. Also, the right selection of the candidates for CRT is critical to receive the most benefit of this therapy. The target of this review article is to describe the efficacy and the indication of CRT, which can be of any help to enroll more patients with heart failure who are likely to get benefits through CRT.

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“…Over the last two decades, as a result of several landmark trials demonstrating mortality and morbidity benefits with cardiac resynchronization therapy (CRT) with or without defibrillation insertion,1, 2, 3 CRT has become a standard of care in select patients with systolic heart failure and concomitant left ventricular dyssynchrony. Substantial limitations of CRT include not only the 30–40% of recipients classified as ‘non‐responders’2 but also significant heterogeneity in the commonly used criteria of response and poor agreement between these different clinical and echocardiographic parameters of response 4.…”

Section: Introductionmentioning

confidence: 99%

Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

et al. 2017

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AimsTo evaluate whether peripheral circulatory ‘remodelling’ as measured by changes in vascular compliance and in markers of nitric oxide signalling contributes to patient response to cardiac resynchronization therapy (CRT).Methods and resultsEffects of CRT were evaluated in 33 patients pre‐procedure and 6 months post‐procedure. Peak oxygen consumption, 6 min walk distance, New York Heart Association class, and quality of life score were evaluated. Augmentation index and its interactions with nitric oxide (NO) were evaluated by applanation tonometry. Platelet NO responsiveness and content of thioredoxin‐interacting protein were assessed. Plasma concentrations of N‐terminal proBNP, asymmetric and symmetric dimethylarginine (SDMA), high sensitivity C‐reactive protein, catecholamines, and matrix metalloproteinases‐2 and ‐9 were assessed. Despite significant improvement in 6 min walk distance (P = 0.005), New York Heart Association class (P < 0.001), quality of life (P = 0.001), and all echocardiographic parameters post‐CRT, there were no significant changes in augmentation index measurements, thioredoxin‐interacting protein content, and platelet NO response. Significant falls in N‐terminal proBNP (P = 0.008) and SDMA (P = 0.013; independent of renal function) occurred. Falls in SDMA predicted reduction in high‐sensitivity C‐reactive protein (P = 0.04) and increases in peak oxygen consumption (P = 0.04). There were no correlations between changes in echocardiographic parameters and those in vascular function.ConclusionsThese data suggest that the beneficial effects of CRT over 6 months are independent of any change in peripheral NO‐related signalling. However, there is evidence that suppression of inflammation occurs, and its magnitude predicts extent of clinical improvement.

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Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure

Abstract: In patients with advanced heart failure and a prolonged QRS interval, cardiac-resynchronization therapy decreases the combined risk of death from any cause or first hospitalization and, when combined with an implantable defibrillator, significantly reduces mortality.

Cited by 5,180 publications

References 20 publications

Cardiac resynchronization therapy outcomes in patients under nonoptimal medical therapy

Cardiac resynchronization therapy outcomes in patients under nonoptimal medical therapy

Up‐to‐date cardiac resynchronization therapy

Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

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