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

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Veazie, Peter J.¹  Noyes, Katia¹  Li, Qinghua¹  Hall, W. Jackson²  Buttaccio, April³  Thevenet-Morrison, Kelly¹  Moss, Arthur J.³ 

[1] Univ Rochester, Dept Community & Prevent Med, Med Ctr, Rochester, NY 14642 USA

[2] Univ Rochester, Med Ctr, Dept Biostat & Computat Biol, Rochester, NY 14642 USA

[3] Univ Rochester, Med Ctr, Dept Med, Rochester, NY 14642 USA

关键词: cardiac-resynchronization therapy (CRT);    heart failure;    implantable cardioverter-defibrillator (ICD);    KCCQ;    MADIT-CRT;    quality-of-life;   

DOI  :  10.1016/j.jacc.2012.06.054

来源: Elsevier

【 摘 要 】

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. (J Am Coll Cardiol 2012;60:1940-4) (C) 2012 by the American College of Cardiology Foundation

【 授权许可】

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