AIMS: Cardiac resynchronization therapy (CRT) is currently limited to those with left ventricular ejection fraction (LVEF) < or =35%. To evaluate whether patients with LVEF >35% might benefit from CRT, we performed a retrospective analysis of the predictors of response to CRT (PROSPECT) database. METHODS AND RESULTS: PROSPECT was a prospective, multicentre study that enrolled CRT patients based on enrolling centre-evaluated LVEF <35%, but all echocardiograms were subsequently analysed by a core laboratory. Patients with core laboratory-measured LVEF >35% (OVER35) were compared with those whose LVEF was <35% (UNDER35). Clinical composite score (CCS) and change in LV end systolic volume (LVESV) were analysed from baseline to 6-month follow-up. Of 361 patients, 86 (24%) had LVEF >35%. At entry, OVER35 had smaller LV volumes, shorter QRS duration, shorter 6-min walk distance, and were more likely to have ischaemic aetiology than UNDER35. Outcomes were comparable between the groups, with 62.8% of OVER35 improved in CCS (70.2% in UNDER35) and 50.8% of OVER35 improved in LVESV (57.8% in UNDER35). CONCLUSION: Patients with LVEF >35%, New York heart association functional Class III-IV status, and QRS >130 ms appear to derive clinical and structural benefit from CRT. As CRT may offer a valuable option for these patients, this hypothesis should be formally tested in a prospective, randomized multicentre trial.
RCT Entities:
AIMS: Cardiac resynchronization therapy (CRT) is currently limited to those with left ventricular ejection fraction (LVEF) < or =35%. To evaluate whether patients with LVEF >35% might benefit from CRT, we performed a retrospective analysis of the predictors of response to CRT (PROSPECT) database. METHODS AND RESULTS: PROSPECT was a prospective, multicentre study that enrolled CRT patients based on enrolling centre-evaluated LVEF <35%, but all echocardiograms were subsequently analysed by a core laboratory. Patients with core laboratory-measured LVEF >35% (OVER35) were compared with those whose LVEF was <35% (UNDER35). Clinical composite score (CCS) and change in LV end systolic volume (LVESV) were analysed from baseline to 6-month follow-up. Of 361 patients, 86 (24%) had LVEF >35%. At entry, OVER35 had smaller LV volumes, shorter QRS duration, shorter 6-min walk distance, and were more likely to have ischaemic aetiology than UNDER35. Outcomes were comparable between the groups, with 62.8% of OVER35 improved in CCS (70.2% in UNDER35) and 50.8% of OVER35 improved in LVESV (57.8% in UNDER35). CONCLUSION:Patients with LVEF >35%, New York heart association functional Class III-IV status, and QRS >130 ms appear to derive clinical and structural benefit from CRT. As CRT may offer a valuable option for these patients, this hypothesis should be formally tested in a prospective, randomized multicentre trial.
Authors: William T Abraham; JoAnn Lindenfeld; Vivek Y Reddy; Gerd Hasenfuss; Karl-Heinz Kuck; John Boscardin; Robert Gibbons; Daniel Burkhoff Journal: J Card Fail Date: 2014-10-05 Impact factor: 5.712
Authors: Angela B S Santos; Elisabeth Kraigher-Krainer; Natalie Bello; Brian Claggett; Michael R Zile; Burkert Pieske; Adriaan A Voors; John J V McMurray; Milton Packer; Toni Bransford; Marty Lefkowitz; Amil M Shah; Scott D Solomon Journal: Eur Heart J Date: 2013-10-27 Impact factor: 29.983
Authors: Daniel Y Wang; Lauren A Kelly; Marc E Richmond; T Alexander Quinn; Bin Cheng; Michelle D Spotnitz; Santos E Cabreriza; Yoshifumi Naka; Allan S Stewart; Craig R Smith; Henry M Spotnitz Journal: Tex Heart Inst J Date: 2013
Authors: John G F Cleland; Karina V Bunting; Marcus D Flather; Douglas G Altman; Jane Holmes; Andrew J S Coats; Luis Manzano; John J V McMurray; Frank Ruschitzka; Dirk J van Veldhuisen; Thomas G von Lueder; Michael Böhm; Bert Andersson; John Kjekshus; Milton Packer; Alan S Rigby; Giuseppe Rosano; Hans Wedel; Åke Hjalmarson; John Wikstrand; Dipak Kotecha Journal: Eur Heart J Date: 2018-01-01 Impact factor: 29.983