Effect of Cardiac Resynchronization Therapy in Patients With New York Heart Association Functional Class IV Heart Failure

Bommel, Rutger J. van; Rijnsoever, E. van; Borleffs, C. Jan Willem; Delgado, Victoria; Marsan, Nina Ajmone; Bertini, Matteo; Schalij, Martin J.; Bax, Jeroen J.

doi:10.1016/j.amjcard.2010.06.025

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…81 Nineteen single-armed prospective and retrospective cohort studies found that heart failure hospitalization or death occurred in men more than in women. 28,44,52,79,83,86,87,90,91,93,94,107,111,114,115,117,118 Some studies, however, found that there were no sex differences in mortality and that men were less likely to experience adverse events compared with women, but these findings were not statistically significant. 80,109 Device-related complications Two articles included data on device-related complications.…”

Section: Hospitalization and Mortalitymentioning

confidence: 86%

“…19,22,28,44,50,52,[79][80][81]83,[85][86][87][88][89][90][91][92][93][94]107,110,114,118 There were 42 studies that reported CRT heart failure hospitalization or death using hazard ratios; 83% of the outcomes showed a greater benefit in women. More specifically, the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) trial enrolled 1820 heart failure patients randomly assigned (3:2 ratio) to CRT-D (n = 1089) or standard implantable defibrillators (ICD) alone (n = 731).…”

Section: Hospitalization and Mortalitymentioning

confidence: 99%

“…103,106 Of these 100 articles, 56 included comparisons of means or risk ratio estimates of effectiveness analyses of improvement in NYHA heart failure class, ejection fraction, and left ventricular volumes. 19,21,24,25,107 Twenty-two articles discussed sex-specific outcomes for hospitalization and death 44,[50][51][52][79][80][81][82][83][84]110 or death alone, 19,28,[85][86][87][88][89][90][91][92][93][94]114,[116][117][118] 2 included device-related complications, 120,121 and 20 included baseline characteristics stratified by sex (Fig. 1).…”

Section: Searchmentioning

confidence: 99%

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Sex Differences in Device Therapy for Heart Failure: Utilization, Outcomes, and Adverse Events

Herz

Engeda

Zusterzeel

et al. 2015

Journal of Women's Health

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Section: Hospitalization and Mortalitymentioning

confidence: 86%

Section: Hospitalization and Mortalitymentioning

confidence: 99%

Section: Searchmentioning

confidence: 99%

See 1 more Smart Citation

Sex Differences in Device Therapy for Heart Failure: Utilization, Outcomes, and Adverse Events

Herz

Engeda

Zusterzeel

et al. 2015

Journal of Women's Health

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“…40 CRT should not be withheld if these individuals are ambulatory, because studies have shown that CRT can decrease LV volumes and improve cardiac function in these patients. 40 If the disease is advanced, however, a robust improvement in overall functional status should not be expected.…”

Section: Cardiac Resynchronization Therapymentioning

confidence: 99%

Devices in the management of advanced, chronic heart failure

Abraham

Smith

2012

Nat Rev Cardiol

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Heart failure (HF) is a global phenomenon, and the overall incidence and prevalence of the condition are steadily increasing. Medical therapies have proven efficacious, but only a small number of pharmacological options are in development. When patients cease to respond adequately to optimal medical therapy, cardiac resynchronization therapy has been shown to improve symptoms, reduce hospitalizations, promote reverse remodelling, and decrease mortality. However, challenges remain in identifying the ideal recipients for this therapy. The field of mechanical circulatory support has seen immense growth since the early 2000s, and left ventricular assist devices (LVADs) have transitioned over the past decade from large, pulsatile devices to smaller, more-compact, continuous-flow devices. Infections and haematological issues are still important areas that need to be addressed. Whereas LVADs were once approved only for ‘bridge to transplantation’, these devices are now used as destination therapy for critically ill patients with HF, allowing these individuals to return to the community. A host of novel strategies, including cardiac contractility modulation, implantable haemodynamic-monitoring devices, and phrenic and vagus nerve stimulation, are under investigation and might have an impact on the future care of patients with chronic HF.

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“…NYHA class IV patients with advanced HF probably have the worst symptoms, but they also have the worst response to CRT [8]. CRT can reverse the remodeling process in a wide variety of situations in completely asymptomatic patients [9,10] as well as class IV patients (± inotropic support) with the most severe form of congestion [11][12][13][14][15]. The guidelines need to address the role of CRT in hospitalized NYHA class IV heart failure patients or those who depend on inotropic therapy because randomized CRT trials have not included these patients.…”

Section: Introductionmentioning

confidence: 99%

Electrical devices for left ventricular dysfunction and heart failure: do we need revised guidelines?

Guglin

Barold

2011

J Interv Card Electrophysiol

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Three recent trials have demonstrated the benefit of cardiac resynchronization therapy (CRT) in the New York Heart Association (NYHA) class II patients with heart failure (HF) with ischemic or nonischemic cardiomyopathy as well as in NYHA class I (asymptomatic) patients mostly with ischemic cardiomyopathy. Earlier intervention with CRT in asymptomatic or minimally symptomatic patients improves survival and reduces HF hospitalizations. The reduction or the prevention of HF hospitalizations is of paramount importance because the HF episodes seem to alter the natural history of disease and are associated with deterioration of left ventricular (LV) function and a marked increase in mortality. The CRT benefit is greatest in patients with a QRS ≥ 150 ms. At this time, it would seem prudent to consider CRT-D (D = ICD) therapy for class I NYHA patients with a QRS ≥ 150 ms and an LV ejection fraction ≤ 30% regardless of etiology. Although the data for NYHA class I patients with nonischemic cardiomyopathy are scanty, the recommendation for class I patients is justified because CRT achieves a much greater degree of LV reverse remodeling in nonischemic compared to ischemic patients. With regard to lone ICDs, there is no evidence that they prevent sudden cardiac death more efficiently in symptomatic than in asymptomatic patients. Cardiomyopathy should be the primary target for device therapy regardless of symptoms for both CRT and lone ICD therapy. New guidelines are needed to address the role of CRT in hospitalized NYHA class IV HF patients or those who depend on inotropic therapy or an LV assist device because randomized CRT trials have not included these patients. CRT in these patients remains controversial. The mortality of such patients even with CRT is very high despite the occasional positive response. The role of CRT in patients waiting for cardiac transplantation also needs guidelines. With the expansion of CRT indications to minimally symptomatic or asymptomatic patients, the benefit of device therapy must be carefully weighed against the potential risk of lifelong device complications.

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Effect of Cardiac Resynchronization Therapy in Patients With New York Heart Association Functional Class IV Heart Failure

Cited by 10 publications

References 21 publications

Sex Differences in Device Therapy for Heart Failure: Utilization, Outcomes, and Adverse Events

Sex Differences in Device Therapy for Heart Failure: Utilization, Outcomes, and Adverse Events

Devices in the management of advanced, chronic heart failure

Electrical devices for left ventricular dysfunction and heart failure: do we need revised guidelines?

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