This study was designed to predict the response and prognosis after cardiac re synchronization therapy(CRT) in patients with end-stage heart failure(HF). Card iac resynchronization therapy improves HF symptoms, exerci...This study was designed to predict the response and prognosis after cardiac re synchronization therapy(CRT) in patients with end-stage heart failure(HF). Card iac resynchronization therapy improves HF symptoms, exercise capacity, and left ventricular(LV) function. Because not all patients respond, preimplantation iden tification of responders is needed. In the present study, response to CRT was pr edicted by the presence of LV dyssynchrony assessed by tissue Doppler imaging. M oreover, the prognostic value of LV dyssynchrony in patients undergoing CRT was assessed. Eighty-five patients with end-stage HF, QRS duration >120 ms, and le ft bundle-branch block were evaluated by tissue Doppler imaging before CRT. At baseline and six months follow-up, New York Heart Association functional class, quality of life and 6-min walking distance, LV volumes, and LV ejection fracti on were determined. Events (death, hospitalization for decompensated HF) were ob tained during one-year follow-up. Responders(74%) and nonresponders(26%) had comparable baseline characteristics, except for a larger dyssynchrony in respon ders (87±49 ms vs. 35±20 ms, p< 0.01). Receiver-operator characteristic curve analysis demonstrated that an optimal cutoff value of 65 ms for LV dyssynchrony yielded a sensitivity and specificity of 80%to predict clinical improvement an d of 92%to predict LV reverse remodeling. Patients with dyssynchrony ≥65 ms ha d an excellent prognosis(6%event rate) after CRT as compared with a 50%event r ate in patients with dyssynchrony< 65 ms(p< 0.001). Patients with LV dyssynchron y< 65 ms respond to CRT and have an excellent prognosis after CRT.展开更多
Cardiac Resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We evaluated its effects on ...Cardiac Resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We evaluated its effects on morbidity and mortality. METHODS: Patients with New York Heart Association class IEt or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony who were receiving standard pharmacologic therapy were randomly assigned to receive medical therapy alone or with cardiac Resynchronization. The primary end point was the time to death from any cause or an unplanned hospitalization for a major cardiovascular event The principal secondary end point was death from any cause. RESULTS: A total of 813 patients were enrolled and followed for a mean of 29.4 months. The primary end point was reached by 159 patients in the cardiac-Resynchronization group, as compared with 224 patients in the medical-therapy group(39 percent vs. 55 percent; hazard ratio, 0.63; 95 percent confidence interval, 0.51 to 0.77; P< 0.001). There were 82 deaths in the cardiac-Resynchronization group, as compared with 120 in the medical-therapy group(20 percent vs. 30 percent; hazard ratio 0.64; 95 percent confidence interval, 0.48 to 0.85; P< 0.002). As compared with medical therapy, cardiac Resynchronization reduced the interventricular mechanical delay, the end-systolic volume index, and the area of the mitral regurgitant jet; increased the left ventricular ejection fraction; and improved symptoms and the quality of life(P< 0.01 for all comparisons). CONCLUSIONS: In patients with heart failure and cardiac dyssynchrony, cardiac Resynchronization improves symptoms and the quality of life and reduces complications and the risk of death. These benefits are in addition to those afforded by standard pharmacologic therapy. The implantation of a cardiac-Resynchronization device should routinely be considered in such patients.展开更多
文摘This study was designed to predict the response and prognosis after cardiac re synchronization therapy(CRT) in patients with end-stage heart failure(HF). Card iac resynchronization therapy improves HF symptoms, exercise capacity, and left ventricular(LV) function. Because not all patients respond, preimplantation iden tification of responders is needed. In the present study, response to CRT was pr edicted by the presence of LV dyssynchrony assessed by tissue Doppler imaging. M oreover, the prognostic value of LV dyssynchrony in patients undergoing CRT was assessed. Eighty-five patients with end-stage HF, QRS duration >120 ms, and le ft bundle-branch block were evaluated by tissue Doppler imaging before CRT. At baseline and six months follow-up, New York Heart Association functional class, quality of life and 6-min walking distance, LV volumes, and LV ejection fracti on were determined. Events (death, hospitalization for decompensated HF) were ob tained during one-year follow-up. Responders(74%) and nonresponders(26%) had comparable baseline characteristics, except for a larger dyssynchrony in respon ders (87±49 ms vs. 35±20 ms, p< 0.01). Receiver-operator characteristic curve analysis demonstrated that an optimal cutoff value of 65 ms for LV dyssynchrony yielded a sensitivity and specificity of 80%to predict clinical improvement an d of 92%to predict LV reverse remodeling. Patients with dyssynchrony ≥65 ms ha d an excellent prognosis(6%event rate) after CRT as compared with a 50%event r ate in patients with dyssynchrony< 65 ms(p< 0.001). Patients with LV dyssynchron y< 65 ms respond to CRT and have an excellent prognosis after CRT.
文摘Cardiac Resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We evaluated its effects on morbidity and mortality. METHODS: Patients with New York Heart Association class IEt or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony who were receiving standard pharmacologic therapy were randomly assigned to receive medical therapy alone or with cardiac Resynchronization. The primary end point was the time to death from any cause or an unplanned hospitalization for a major cardiovascular event The principal secondary end point was death from any cause. RESULTS: A total of 813 patients were enrolled and followed for a mean of 29.4 months. The primary end point was reached by 159 patients in the cardiac-Resynchronization group, as compared with 224 patients in the medical-therapy group(39 percent vs. 55 percent; hazard ratio, 0.63; 95 percent confidence interval, 0.51 to 0.77; P< 0.001). There were 82 deaths in the cardiac-Resynchronization group, as compared with 120 in the medical-therapy group(20 percent vs. 30 percent; hazard ratio 0.64; 95 percent confidence interval, 0.48 to 0.85; P< 0.002). As compared with medical therapy, cardiac Resynchronization reduced the interventricular mechanical delay, the end-systolic volume index, and the area of the mitral regurgitant jet; increased the left ventricular ejection fraction; and improved symptoms and the quality of life(P< 0.01 for all comparisons). CONCLUSIONS: In patients with heart failure and cardiac dyssynchrony, cardiac Resynchronization improves symptoms and the quality of life and reduces complications and the risk of death. These benefits are in addition to those afforded by standard pharmacologic therapy. The implantation of a cardiac-Resynchronization device should routinely be considered in such patients.
