Cardiac resynchronisation improves survival in mild heart failure!

[摘要] Several studies have already established the superiority of cardiac resynchronisation therapy (CRT)-defibrillator (D) over implantable cardioverter-defibrillator (ICD) alone in patients with severely symptomatic chronic heart failure (New York Heart Association (NYHA) class III/IV), left ventricular (LV) systolic dysfunction, and a wide QRS complex. Synchronous pacing of opposing LV walls in malfunctioning asynchronously contracting LV regions creates resynchronisation with restoration of LV motion dynamics. In the Multicenter Automatic Defibrillator Implantation Trial-CRT (MADIT-CRT) study, a reduction in mortality or hospitalisation for congestive heart failure with CRT-D was observed compared with ICD. However, no difference in mortality was noted between the two groups. The COMPANION study established the superiority of CRT-D over optimal medical management alone in reducing all-cause mortality patients with NYHA class III/IV symptoms. While improvements in LV dimensions with CRT in patients with mildly asymptomatic heart failure were observed in the MIRACLE ICD-II and REVERSE trials, there were no significant differences in clinical endpoints in these studies. The MADIT-CRT study showed a significant reduction in the composite endpoint of mortality or heart failure events in similar patients with NYHA class I/II symptoms over a mean follow-up of 2 years. However, no significant difference in all-cause mortality between the two groups was noted.

[学科分类] 心脏病和心血管学