Long-term effects of upgrading from right ventricular pacing to cardiac resynchronization therapy in patients with heart failure

被引:45
作者
Foley, Paul W. X. [1 ]
Muhyaldeen, Sahrkaur A. [1 ]
Chalil, Shajil [1 ]
Smith, Russell E. A. [1 ]
Sanderson, John E. [1 ]
Leyva, Francisco [1 ]
机构
[1] Univ Birmingham, Dept Cardiol, Good Hope Hosp, Birmingham B75 7RR, W Midlands, England
来源
EUROPACE | 2009年 / 11卷 / 04期
关键词
Cardiac resynchronization therapy; Pacing; Heart failure; CHRONIC ATRIAL-FIBRILLATION; PACEMAKER PATIENTS; DYSFUNCTION; ACTIVATION; MORBIDITY; MORTALITY; STRAIN; DELAY; TRIAL;
D O I
10.1093/europace/eup037
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
To determine the effects of upgrading from right ventricular (RV) pacing to cardiac resynchronization therapy (CRT) in patients with heart failure. Patients with heart failure [age 67.3 +/- 9.6 years (mean +/- SD), NYHA class III or IV, left ventricular ejection fraction (LVEF) <= 35%, QRS >= 120 ms] underwent de novo CRT (n = 336) or upgrading from RV pacing [n = 58; VVIR in 24, DDDR in 34] to CRT. The endpoint of death from any cause or major cardiovascular events, cardiovascular death or hospitalization for heart failure, and cardiovascular death or death from any cause was determined after a maximum follow-up of 7.7 years. No differences emerged between the de novo CRT and the upgrade-to-CRT groups with respect to any of the clinical endpoints. The de novo CRT and upgrade-to-CRT groups derived similar improvements in NYHA class [-1.2 vs. -1.3 (mean), both P < 0.0001), 6 min walking distance [75.9 (P < 0.0001) vs. 46.4 (P = 0.0205) m], and quality of life scores [-25.2 vs. -18.7 (both P < 0.0001)] 1 year after implantation. Response rates using a combined clinical score (>= 1 NYHA classes or >= 25% increase in 6 min walking distance plus survival with freedom from heart failure hospitalizations for 1 year) were 73.2% and 75.4%, respectively (P = NS). There were reductions in left ventricular end-systolic volume [median of 20.3 mL (P = 0.0012) and 22.7 mL (P = 0.0066), respectively] and improvements in LVEF [median of 2.9% and 9.3%, respectively (both P < 0.0001)]. In patients with heart failure who are RV-paced, upgrading to CRT is associated with a similar long-term risk of mortality and morbidity to patients undergoing de novo CRT. Symptomatic improvements and degree of reverse remodelling are also comparable.
引用
收藏
页码:495 / 501
页数:7
相关论文
共 33 条
[1]   Cardiac resynchronization in chronic heart failure [J].
Abraham, WT ;
Fisher, WG ;
Smith, AL ;
Delurgio, DB ;
Leon, AR ;
Loh, E ;
Kocovic, DZ ;
Packer, M ;
Clavell, AL ;
Hayes, DL ;
Ellestad, M ;
Messenger, J ;
Trupp, RJ ;
Underwood, J ;
Pickering, F ;
Truex, C ;
McAtee, P .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (24) :1845-1853
[2]  
ADOMIAN G, 1985, AM HEART J, V112, P79
[3]   Myocardial infarction redefined -: A consensus Document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction [J].
Alpert, JS ;
Antman, E ;
Apple, F ;
Armstrong, PW ;
Bassand, JP ;
de Luna, AB ;
Beller, G ;
Breithardt, G ;
Chaitman, BR ;
Clemmensen, P ;
Falk, E ;
Fishbein, MC ;
Galvani, M ;
Garson, A ;
Grines, C ;
Hamm, C ;
Jaffe, A ;
Katus, H ;
Kjekshus, J ;
Klein, W ;
Klootwijk, P ;
Lenfant, C ;
Levy, D ;
Levy, RI ;
Luepker, R ;
Marcus, F ;
Näslund, U ;
Ohman, M ;
Pahlm, O ;
Poole-Wilson, P ;
Popp, R ;
Alto, P ;
Pyörälä, K ;
Ravkilde, J ;
Rehnquist, N ;
Roberts, W ;
Roberts, R ;
Roelandt, J ;
Rydén, L ;
Sans, S ;
Simoons, ML ;
Thygesen, K ;
Tunstall-Pedoe, H ;
Underwood, R ;
Uretsky, BF ;
Van de Werf, F ;
Voipio-Pulkki, LM ;
Wagner, G ;
Wallentin, L ;
Wijns, W .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (03) :959-969
[4]   Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome [J].
Andersen, HR ;
Nielsen, JC ;
Thomsen, PEB ;
Thuesen, L ;
Mortensen, PT ;
Vesterlund, T ;
Pedersen, AK .
LANCET, 1997, 350 (9086) :1210-1216
[5]   Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy [J].
Assomull, Ravi G. ;
Prasad, Sanjay K. ;
Lyne, Jonathan ;
Smith, Gillian ;
Burman, Elizabeth D. ;
Khan, Mohammed ;
Sheppard, Mary N. ;
Poole-Wilson, Philip A. ;
Pennell, Dudley J. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (10) :1977-1985
[6]   Addition of a left ventricular lead to conventional pacing systems in patients with congestive heart failure: Feasibility, safety, and early results in 60 consecutive patients [J].
Baker, CM ;
Christopher, TJ ;
Smith, PF ;
Langberg, JJ ;
Delurgio, DB ;
Leon, AR .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2002, 25 (08) :1166-1171
[7]   ALTERATIONS IN LEFT-VENTRICULAR RELAXATION DURING ATRIOVENTRICULAR PACING IN HUMANS [J].
BEDOTTO, JB ;
GRAYBURN, PA ;
BLACK, WH ;
RAYA, TE ;
MCBRIDE, W ;
HSIA, HH ;
EICHHORN, EJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1990, 15 (03) :658-664
[8]   Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure [J].
Bristow, MR ;
Saxon, LA ;
Boehmer, J ;
Krueger, S ;
Kass, DA ;
De Marco, T ;
Carson, P ;
DiCarlo, L ;
DeMets, D ;
White, BG ;
DeVries, DW ;
Feldman, AM .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (21) :2140-2150
[9]   Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. [J].
Cazeau, S ;
Leclercq, C ;
Lavergne, T ;
Walker, S ;
Varma, C ;
Linde, C ;
Garrigue, S ;
Kappenberger, L ;
Haywood, GA ;
Santini, M ;
Bailleul, C ;
Daubert, JC .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (12) :873-880
[10]   The effect of cardiac resynchronization on morbidity and mortality in heart failure [J].
Cleland, JGF ;
Daubert, J ;
Erdmann, E ;
Freemantle, N ;
Gras, D ;
Kappenberger, L ;
Tavazzi, L ;
Cleland, JGF ;
Daubert, JC ;
Erdmann, E ;
Gras, D ;
Kappenberger, L ;
Klein, W ;
Tavazzi, L ;
Poole-Wilson, PA ;
Rydén, L ;
Wedel, H ;
Wellens, HJJ ;
Uretsky, B ;
Thygesen, K ;
Böcker, D ;
Marijianowski, MMH ;
Freemantle, N ;
Calvert, MJ ;
Christ, G ;
Fruhwald, F ;
Hofmann, R ;
Krypta, A ;
Leisch, F ;
Pacher, R ;
Rauscha, F ;
Tavernier, R ;
Thomsen, PEB ;
Boesgaard, S ;
Eiskjær, H ;
Esperen, GT ;
Haarbo, J ;
Hagemann, A ;
Korup, E ;
Moller, M ;
Mortensen, P ;
Sogaard, P ;
Vesterlund, T ;
Huikuri, H ;
Niemelä, KI ;
Toivonen, L ;
Bauer, F ;
Cohen-Solal, A ;
Crocq, C ;
Djiane, P .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 352 (15) :1539-1549