Comparison of Cardiac Resynchronization Therapy Outcomes in Patients With New York Heart Association Functional Class I/II Versus III/IV Heart Failure

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• 作者：Alan J. Bank ; MD¹ ; ² ; ^{alan.bank@allina.com} ; Ariel Rischall ; BS¹ ; Ryan M. Gage ; MS¹ ; Kevin V. Burns ; PhD¹ ; ² ; Spencer H. Kubo ; MD¹
• 关键词：Cardiac resynchronization therapy ; heart failure ; remodeling ; NYHA functional classification
• 刊名：Journal of Cardiac Failure
• 出版年：2012
• 期刊代码：162_10719164
• 类别：med
• 出版时间：May, 2012
• 卷：18
• 期：5
• 页码：373-378
• 文件大小：247 K

摘要

Background

Several randomized trials have shown that cardiac resynchronization therapy (CRT) benefits New York Heart Association (NYHA) functional class I/II heart failure (HF) patients, but it is unknown if similar outcomes occur in the real-world.

Methods and Results

All patients receiving CRT between 2003 and 2008 with ejection fraction (EF) 鈮?5%and QRS duration 鈮?20 ms were included. Outcomes assessed were subjective clinical response, echocardiographic response, and survival free of cardiovascular (CV) hospitalization. Baseline demographics in functional class I/II (n聽= 155) and functional class III/IV (n聽= 512) were similar, except for differences in age and several comorbidities. Clinical response was similar in both groups. The functional class I/II group had a greater decrease in left ventricular (LV) end-diastolic dimension (P聽= .031), and trended toward greater improvements in LV end-systolic dimension (P聽= .056) and EF (P聽= .059). The functional class I/II group had a better 5-year survival rate (79 vs 54%; P < .0001) and survival free of CV hospitalization (45%vs 26%; P < .0001).

Conclusions

In this real-world clinical scenario, NYHA functional class I/II CRT patients improved clinical status, and LV function and size as good as or better than those in NYHA functional class III/IV patients. These observations provide further support for the use of CRT in patients with mild symptoms of HF.