The Influence of Left Ventricular Ejection Fraction on the Effectiveness of Cardiac Resynchronization Therapy MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy)

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:61

Article

Kutyifa, Valentina^1,2  Kloppe, Axel³  Zareba, Wojciech¹  Solomon, Scott D.⁴  McNitt, Scott¹  Polonsky, Slava¹  Barsheshet, Alon¹  Merkely, Bela²  Lemke, Bernd³  Nagy, Vivien Klaudia²  Moss, Arthur J.¹  Goldenberg, Ilan¹ 

[1] Univ Rochester, Med Ctr, Rochester, NY 14642 USA

[2] Semmelweis Univ, Ctr Heart, H-1085 Budapest, Hungary

[3] Bergmannsheil Ruhr Univ, Dept Cardiol & Angiol, Bochum, Germany

[4] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Cardiovasc, Boston, MA 02115 USA

关键词: cardiac resynchronization therapy;    heart failure;    implantable cardioverter-defibrillator;    left ventricular ejection fraction;   

DOI  :  10.1016/j.jacc.2012.11.051

来源: Elsevier

【 摘 要 】

Objectives The goal of this study was to evaluate the influence of left ventricular (LV) lead position on the risk of ventricular tachyarrhythmia in patients undergoing cardiac resynchronization therapy (CRT). Background Left ventricular ejection fraction (LVEF) is a surrogate marker of heart failure (HF) status and associated risk. Data on the effectiveness of cardiac resynchronization therapy with defibrillator (CRT-D) in patients with mild HF and better LVEF are limited. Methods In the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study, the echocardiography core laboratory assessed baseline LVEF independent of the enrolling centers and identified a range of LVEFs, including those >30% (i.e., beyond the eligibility criteria). Echocardiographic response with CRT, defined as percent change in left ventricular end-diastolic volume (LVEDV), was analyzed in 3 prespecified LVEF groups: >30%, 26% to 30%, and <= 25%. The primary endpoint was HF or death. Secondary endpoint included all-cause mortality. Results LVEF was evaluated in 1,809 study patients. There were 696 (38%) patients with LVEF >30% (in the range of 30.1% to 45.3%); 914 patients (50.5%) with LVEF 26% to 30%; and 199 patients with LVEF <= 25% (11%). The mean reduction in LVEDV with CRT-D therapy at the 1-year follow-up was directly related to increasing LVEF (LVEF >30%: 22.3%; LVEF 26% to 30%: 20.1%; and LVEF <= 25%: 18.7% reduction, respectively [p = 0.001]). CRT-D treatment similarly reduced the risk of HF/death in patients with LVEF >30% (hazard ratio [HR]: = 0.56 [95% confidence interval (CI): 0.39 to 0.82], p = 0.003), LVEF 26% to 30% (HR: 0.67: [95% CI: 0.50 to 0.90], p = 0.007), and LVEF <= 25% (HR: 0.57 [95% CI: 0.35 to 0.95], p = 0.03; all p values for LVEF-by-treatment interactions >0.1). Conclusions In MADIT-CRT, the clinical benefit of CRT was evident regardless of baseline LVEF, including those with LVEF >30%, whereas the echocardiographic response was increased with increasing LVEF, indicating that CRT might benefit patients with better LVEF. (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271) (J Am Coll Cardiol 2013;61:936-44) (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

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