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J Am Coll Cardiol. 2012 Nov 6;60(19):1940-4. doi: 10.1016/j.jacc.2012.06.054. Epub 2012 Oct 10.

Cardiac resynchronization and quality of life in patients with minimally symptomatic heart failure.

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  • 1Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, NY, USA. peter_veazie@urmc.rochester.edu

Abstract

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.

Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PMID:
23062542
[PubMed - indexed for MEDLINE]
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