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Response to preventive cardiac resynchronization therapy in patients with ischaemic and nonischaemic cardiomyopathy in MADIT-CRT.

Publication ,  Journal Article
Barsheshet, A; Goldenberg, I; Moss, AJ; Eldar, M; Huang, DT; McNitt, S; Klein, HU; Hall, WJ; Brown, MW; Goldberger, JJ; Goldstein, RE ...
Published in: Eur Heart J
July 2011

AIMS: There are no data regarding the differential response to cardiac resynchronization therapy with defibrillator (CRT-D) by the aetiology of cardiomyopathy in mildly symptomatic patients. We evaluated the outcome of patients enrolled in MADIT-CRT by ischaemic and non-ischaemic aetiology of cardiomyopathy (ICM and non-ICM, respectively). METHODS AND RESULTS: The clinical response to CRT-D was assessed among ICM (n = 1046) and non-ICM (n = 774) patients enrolled in MADIT-CRT during an average follow-up of 2.4 years, and echocardiographic response was assessed at 1 year. Cardiac resynchronization therapy with defibrillator vs. ICD therapy was associated with respective 34% (P = 0.001) and 44% (P = 0.002) reductions in the risk of heart failure or death among ICM and non-ICM patients (P for interaction = 0.455). In the ICM group, CRT-D was associated with mean (±SD) 29 ± 14% and 18 ± 10% reductions in left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV), respectively. In the non-ICM group, CRT-D was associated with significantly greater volume reductions compared with the ICM group [37 ± 16% and 24 ± 12% reductions in LVESV and LVEDV, respectively (P < 0.001 for all)]. Risk subsets in the ICM group that showed a favourable clinical response to CRT-D included patients with QRS ≥150 ms, systolic blood pressure <115 mmHg, and left bundle branch block (LBBB), whereas in the non-ICM group females, patients with diabetes mellitus, and LBBB, displayed a favourable clinical response. CONCLUSION: Mildly symptomatic ICM and non-ICM patients show significant differences in the echocardiographic response to CRT-D and in the clinical benefit within risk subsets suggesting that risk assessment for CRT-D in this population should be aetiology-specific.

Duke Scholars

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 2011

Volume

32

Issue

13

Start / End Page

1622 / 1630

Location

England

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Stroke Volume
  • Risk Assessment
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Failure
 

Citation

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Barsheshet, A., Goldenberg, I., Moss, A. J., Eldar, M., Huang, D. T., McNitt, S., … Daubert, J. P. (2011). Response to preventive cardiac resynchronization therapy in patients with ischaemic and nonischaemic cardiomyopathy in MADIT-CRT. Eur Heart J, 32(13), 1622–1630. https://doi.org/10.1093/eurheartj/ehq407
Barsheshet, Alon, Ilan Goldenberg, Arthur J. Moss, Michael Eldar, David T. Huang, Scott McNitt, Helmut U. Klein, et al. “Response to preventive cardiac resynchronization therapy in patients with ischaemic and nonischaemic cardiomyopathy in MADIT-CRT.Eur Heart J 32, no. 13 (July 2011): 1622–30. https://doi.org/10.1093/eurheartj/ehq407.
Barsheshet A, Goldenberg I, Moss AJ, Eldar M, Huang DT, McNitt S, et al. Response to preventive cardiac resynchronization therapy in patients with ischaemic and nonischaemic cardiomyopathy in MADIT-CRT. Eur Heart J. 2011 Jul;32(13):1622–30.
Barsheshet, Alon, et al. “Response to preventive cardiac resynchronization therapy in patients with ischaemic and nonischaemic cardiomyopathy in MADIT-CRT.Eur Heart J, vol. 32, no. 13, July 2011, pp. 1622–30. Pubmed, doi:10.1093/eurheartj/ehq407.
Barsheshet A, Goldenberg I, Moss AJ, Eldar M, Huang DT, McNitt S, Klein HU, Hall WJ, Brown MW, Goldberger JJ, Goldstein RE, Schuger C, Zareba W, Daubert JP. Response to preventive cardiac resynchronization therapy in patients with ischaemic and nonischaemic cardiomyopathy in MADIT-CRT. Eur Heart J. 2011 Jul;32(13):1622–1630.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 2011

Volume

32

Issue

13

Start / End Page

1622 / 1630

Location

England

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Stroke Volume
  • Risk Assessment
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Failure