New York Heart Association functional class, QRS duration, and survival in heart failure with reduced ejection fraction: implications for cardiac resychronization therapy

Braunschweig, Frieder; Linde, Cecilia; Benson, Lina; Ståhlberg, Marcus; Dahlström, Ulf; Lund, Lars H.

doi:10.1002/ejhf.563

Cited by 34 publications

(29 citation statements)

References 41 publications

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“…The Institutes of Medicine has identified implementation of safe and effective interventions into broad clinical practice as a major area needing improvement . We have previously described that as many as 30% of HFrEF patients may have indication for CRT, and that wide QRS and LBBB are associated with increased mortality consistently across varying demographics and independently of extensive baseline covariates …”

Section: Introductionmentioning

confidence: 99%

Association between demographic, organizational, clinical, and socio‐economic characteristics and underutilization of cardiac resynchronization therapy: results from the Swedish Heart Failure Registry

Lund

Braunschweig

Benson

et al. 2017

European J of Heart Fail

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Section: Introductionmentioning

confidence: 99%

Association between demographic, organizational, clinical, and socio‐economic characteristics and underutilization of cardiac resynchronization therapy: results from the Swedish Heart Failure Registry

Lund

Braunschweig

Benson

et al. 2017

European J of Heart Fail

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“…Similarly, the 1-year survival rate without CRT was 50-70% in ambulatory classes III-IV HF patients with QRS widening (≥120 ms, n = 2720) from the Swedish Heart Failure Registry. 22 Patients with QRS widening or dependency on IVDs/ISTs, like our patients, usually experience a worse prognosis than those without. 23,24 Outcomes of cardiac resynchronization therapy for intravenous drug/invasive supportive treatment-dependent far-advanced New York Heart Association class-IV heart failure patients…”

Section: Prognosis Of Ambulatory New York Heart Association Class-iv mentioning

confidence: 58%

Cardiac resynchronization therapy in New York Heart Association class‐IV patients dependent on intravenous drugs or invasive supportive treatments

et al. 2020

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Aims We sought to evaluate the effectiveness of cardiac resynchronization therapy (CRT) in far-advanced heart failure (FA-HF) patients with New York Heart Association (NYHA) class-IV status and dependency on intravenous drugs (IVDs) and/or invasive supportive treatments (ISTs). Methods and results Among 305 patients who underwent CRT implantation between October 2005 to December 2019, we identified 17 FA-HF patients with NYHA class-IV status and dependency on IVDs (inotropes, diuretics, vasopressors, or vasodilators) and/or ISTs (extracorporeal membranous oxygenator or continuous renal replacement therapy). All patients (median age = 68.7 years, non-ischaemic cardiomyopathy = 15) remained dependent on several IVDs (2.2 ± 1.3 per patient) and/or ISTs for 11.3 ± 7.8 days due to multiple tapering failure (4.3 ± 3.2 per patient) before CRT implantation. However, 14 (82%) patients were successfully weaned from IVDs/ISTs within 5.2 ± 5.3 days following CRT, and 12 (71%) stayed alive for more than 1 year free of ventricular assist device or heart transplantation with symptom improvement (≥1 NYHA class) and a reduced annual HF hospitalization rate (P = 0.002). Considerable improvements in ventricular systolic function (P = 0.004) and volumetric reverse remodelling (P = 0.007) were noticed during the long-term follow-up period (35 ± 15 months post-CRT). The ventricular assist device/heart transplantation/death-free survival rate post-CRT was 71% and 65% at 1 and 3 years, respectively. Conclusions Cardiac resynchronization therapy implantation may be a feasible treatment that can offer short-term and long-term clinical benefits for NYHA class-IV FA-HF patients who are dependent on IVDs/ISTs. When considering treatment options, CRT should not be prematurely excluded solely based on a patient's dependency on IVDs/ISTs without first attempting to identify favourable CRT response factors.

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“…Symptoms, assessed by NYHA class and QRS duration, but not QRS morphology, had an independent association with mortality in a large Swedish registry including 13 423 patients . Retrospective analyses of randomized trials have shown the independent prognostic value of both QRS duration and QRS morphology .…”

Section: Devices: Prognostic Determinants and Innovative Approachesmentioning

confidence: 99%

March 2017 at a glance: pathophysiology, imaging, biomarkers and devices

Metra

2017

European J of Heart Fail

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New York Heart Association functional class, QRS duration, and survival in heart failure with reduced ejection fraction: implications for cardiac resychronization therapy

Abstract: In HF with reduced LVEF, QRS prolongation is common and independently linked to worse survival. The increase in mortality risk associated with QRS prolongation of both LBBB and non-LBBB morphology is similar in NYHA class II and III-IV.

Cited by 34 publications

References 41 publications

Association between demographic, organizational, clinical, and socio‐economic characteristics and underutilization of cardiac resynchronization therapy: results from the Swedish Heart Failure Registry

Association between demographic, organizational, clinical, and socio‐economic characteristics and underutilization of cardiac resynchronization therapy: results from the Swedish Heart Failure Registry

Cardiac resynchronization therapy in New York Heart Association class‐IV patients dependent on intravenous drugs or invasive supportive treatments

March 2017 at a glance: pathophysiology, imaging, biomarkers and devices

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