CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

February 14th, 2011

CRT Found Beneficial in Less Severe Heart-Failure Patients

Cardiac resynchronization therapy (CRT) appears to be beneficial in patients with less severe heart failure (NYHA class I and II), according to a new systematic review published online in Annals of Internal Medicine. In a previous analysis, Nawaf Al-Majed and colleagues had found that CRT was highly beneficial in HF patients with NYHA class III and IV symptoms. The new analysis incorporates the results of recent trials, including less symptomatic HF patients.

The investigators analyzed data from 25 trials including 9082 patients and found a significant reduction in all-cause mortality and rehospitalizations for HF in NYHA class I and II patients. However, functional outcomes or quality of life did not improve in this group. The relative magnitude of the benefit was similar to that observed in patients with more severe HF.

The authors conclude that their data “supports the expansion of indications for CRT to incorporate less symptomatic patients with HF who have LVEF <30%, QRS duration >120 msec, and are in sinus rhythm.” They estimate that CRT “may well be indicated now for most of the 40% of individuals with systolic HF who have QRS exceeding 120 msec” but acknowledge that eligibility criteria derived from randomized controlled trials is “clearly imperfect.”

Categories: Heart Failure
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One Response to “CRT Found Beneficial in Less Severe Heart-Failure Patients”

  1. Renato De Vecchis, public hospital physician says:
    February 16, 2011 at 8:02 am

    In CHF patients located in I-II NYHA class exhibiting a left bundle branch block, the finding of a beneficial effect of CRT is questionable. The left ventricle dilated so as to attain a marked reduction in left ventricular ejection fraction( less than 30%) is usually characterized by a rather evident deterioration in clinical picture ; so, even though any pertaining therapy is performed, the placing of these patients in I NYHA class is unlikely. When we consider the impact of any therapy, we should also consider the operational difficulties and costs; thus, if a patient with dilated left ventricle has achieved a clinical compensation (I NYHA class) by pharmacologic therapy, any attempt to further ameliorate his wellness feeling and tolerance to effort should account for the operating risks and remarkable costs of this kind of device…

    Competing interests pertaining specifically to this post, comment, or both:
    Conflicts of interest: none