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Addition of ICD to CRT therapy linked with reduction in HF events in patients with mild cardiac symptoms
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Cardiac resynchronization therapy combined with an implantable cardioverter defibrillator was associated with a decreased risk for HF events in relatively asymptomatic patients with a low ejection fraction and wide QRS complex.
Researchers enrolled 1,820 patients with ischemic or nonischemic cardiomyopathy. Patients were randomly assigned to either cardiac resynchronization therapy plus an ICD (CRT–ICD; n=1,089) or to an ICD alone (n=731). Patients were followed for an average of 2.4 years, and the primary endpoint of the study was death from any cause or a nonfatal HF event (whichever came first).
The primary endpoint occurred in 372 patients; 187 (17.2%) in the CRT–ICD group and 185 (25.3%) in the ICD-alone group. HRs for the primary endpoint among patients with ischemic cardiomyopathy did not differ from those for patients without ischemic cardiomyopathy, according to the researchers. There was a reduction in the risk for death or nonfatal HF in the CRT–ICD group vs. ICD-alone (HR=0.66; 95% CI, 0.52-0.84). The superiority of CRT–ICD therapy was indicated by a 41% reduction in the risk for HF. The CRT–ICD therapy was also associated with reduced left ventricular volume (P<.001) and improved ejection fraction (P<.001) vs. ICD-alone therapy. A greater benefit from CRT–ICD therapy in women vs. men (P=.01 for interaction) and in patients with a QRS duration >150 ms (P=.001 for interaction) was reported.
“Our study was designed to address a preventive indication for CRT–ICD therapy in relatively asymptomatic patients receiving appropriate medical treatment who have ischemic heart disease with class I or II symptoms or nonischemic heart disease with class II symptoms, a reduced ejection fraction, a wide QRS complex and sinus rhythm,” the researchers concluded. “This study provides evidence that preventive CRT–ICD therapy decreases the risk for HF events in vulnerable patients with ischemic or nonischemic heart disease who have minimal HF symptoms but a wide QRS complex.”
Moss AJ. N Engl J Med. 2009;361:1329-1338.