Cardiac Resynchronization and Quality of Life in Patients With Minimally Symptomatic Heart Failure

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• 作者：Peter J. Veazie ; PhD^? ; ^{peter_veazie@urmc.rochester.edu} ; Katia Noyes ; PhD ; MPH^? ; Qinghua Li ; MS^? ; W. Jackson Hall ; PhD^&dagger ; ; April Buttaccio ; MPH^&Dagger ; ; Kelly Thevenet-Morrison ; MS^? ; Arthur J. Moss ; MD^&Dagger ;
• 关键词：cardiac-resynchronization therapy (CRT) ; heart failure ; implantable cardioverter-defibrillator (ICD) ; KCCQ ; MADIT-CRT ; quality-of-life
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 出版时间：6 November, 2012
• 年：2012
• 卷：60
• 期：19
• 页码：1940-1944
• 全文大小：670 K

文摘

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Objectives

This study compared the quality of life (QOL) of patients with cardiac resynchronization therapy (CRT) and an implantable cardioverter-defibrillator (ICD) to patients with an ICD only.

Background

CRT with ICD is associated with a reduction in heart failure risk among minimally symptomatic patients. It is unknown whether this improves QOL.

Methods

This study uses the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) data. The MADIT-CRT enrolled 1,820 patients at 110 centers across 14 countries. Patients had ischemic cardiomyopathy (New York Heart Association [NYHA] functional class I or II) or nonischemic cardiomyopathy (NYHA functional class II only), sinus rhythm, an ejection fraction of 30 % or less, and prolonged intraventricular conduction with a QRS duration of 130 ms or more. QOL was evaluated on the 1,699 patients with baseline and follow-up measures using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Six dimensions (Physical Limitation, Symptom Stability, Symptom Frequency, Symptom Burden, Quality of Life, and Social Limitations) and 3 summary scores (Total Symptom, Clinical Summary, and Overall Summary) were analyzed.

Results

During an average follow-up of 2.4 years, the CRT-ICD group had greater improvement than the ICD-only group on all KCCQ measures (p < 0.05 on each scale). These differences were significant among patients with left bundle branch block conduction disturbance (n = 1,204, p < 0.01 on each scale), but not among patients without left bundle branch block (n = 494).

Conclusions

Compared with patients with ICD only, CRT-ICD is associated with greater improvement in QOL among relatively asymptomatic patients, specifically among those with left bundle branch conduction disturbance.