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CRT showed positive effect on patients with minimal HF
Adabag S. J Am Coll Cardiol. 2011;58:935-941.
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Cardiac resynchronization therapy decreased all-cause mortality, reduced HF hospitalizations and improved left ventricular ejection fraction in NYHA Class 1 and Class II patients with HF compared with implantable cardioverter defibrillators, according to a study.
Researchers identified randomized clinical trials published in Medline from 1960 to January 2010 by using “cardiac resynchronization therapy” and “biventricular pacing” as keywords, by searching www.clinicaltrials.gov, and by hand-searching references cited in relevant publications. The search criterion was limited to randomized trials that enrolled asymptomatic or mildly symptomatic HF patients; compared cardiac resynchronization therapy (CRT) vs. ICD alone; and reported mortality, HF, hospitalization, and LV dimensions or volume.
Five clinical trials that included 4,317 patients with NYHA asymptomatic or mildly symptomatic HF (Class I and II) met the criterion, and a meta-analysis on these five clinical trials was performed.
“Patients assigned to CRT had a significantly greater improvement in LVEF and LV volume than ICD patients,” according to the study. From baseline, mean increase in ejection fraction was 5.9% in patients assigned to CRT, whereas patients assigned to ICD had a 2.2% increase. CRT also had a greater reduction in LV end-diastolic dimensions and volume than for ICD.
Of the 4,317 patients with NYHA asymptomatic or mildly symptomatic HF, 9.5% of patients died during follow-up. Mortality was lower among patients assigned to CRT vs. ICD, as well as HF events or hospitalizations, according to the study. Specifically, mildly symptomatic patients were associated with significantly lower mortality and HF hospitalization when assigned to CRT, whereas asymptomatic patients had a lower HF hospitalization risk with CRT, but there was no difference in mortality. Frequency of all-cause mortality was 8% with CRT and 11.5% with ICD, whereas HF hospitalization was 11.6% with CRT and 18.2% with ICD.
“In this systematic review of five randomized clinical trials involving greater than 4,000 patients with asymptomatic or mildly symptomatic HF, reduced [ejection fraction], and wide QRS complex, CRT was associated with a 19% reduction in mortality and 32% reduction in HF events or hospitalization in comparison with ICD therapy alone,” researchers wrote. “Further, CRT was associated with a significant improvement in LV dimensions, volume, and [ejection fraction].”
Disclosure: The researchers report no relevant financial disclosures.
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