open access

Vol 23, No 4 (2016)
ARRHYTMOLOGY Original articles
Published online: 2016-06-16
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Effectiveness of cardiac resynchronization therapy by the frequency of revascularization procedures in ischemic cardiomyopathy patients

Mustafa Husaini, Yitschak Biton, Brad Stair, Arthur J. Moss, Tor Biering-Sørensen, Scott Solomon, Scott McNitt, Bronislava Polonsky, Wojciech Zareba, Alon Barsheshet, Valentina Kutyifa
DOI: 10.5603/CJ.a2016.0032
·
Pubmed: 27320956
·
Cardiol J 2016;23(4):437-445.

open access

Vol 23, No 4 (2016)
ARRHYTMOLOGY Original articles
Published online: 2016-06-16

Abstract

Background: It is not known whether the number of revascularizations modifies clinical outcomes in patients with ischemic cardiomyopathy (ICM) implanted with cardiac resynchronization therapy defibrillator (CRT-D) vs. an implantable cardioverter-defibrillator (ICD)-only.

Methods: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), we evaluated the effect of CRT-D vs. ICD-only on heart failure (HF) or death, on ventricular tachycardia (VT), ventricular fibrillation (VF) or death, and on reverse remodeling in 592 ICM patients with left bundle branch block, by the number of pre-enrollment revascularizations (0, 1 or ≥ 2 revascularizations).

Results: There was a risk reduction of HF/death with CRT-D vs. ICD-only in all three sub-groups: ICM with no need for revascularization (HR 0.51 [0.26–1.02]; p = 0.055), ICM with 1 revascularization (HR 0.45 [0.30–0.70]; p < 0.001), and ICM with 2 or more revas­cularizations (HR 0.37 [0.20–0.66]; p < 0.001). Similarly, there was a risk reduction of VT/ /VF/death with CRT-D vs. ICD-only in patients with no need for revascularization (HR 0.55 [0.31–0.99]; p = 0.044); with 1 revascularization (HR 0.77 [0.51–1.18]; p = 0.23); or with ≥ 2 revascularizations (HR 0.63 [0.34–1.17]; p = 0.14). There was a similar degree of left ventricular reverse remodeling in all three subgroups (p > 0.05 for LVESV, LVEDV, and LAV percent change at 1-year follow-up).

Conclusions: In ICM patients, CRT-D is associated with a reduction in HF or death and VT/VF or death — irrespective of the frequency of pre-enrollment revascularization procedures — and is accompanied by a similar degree of beneficial left ventricular reverse remodeling.

Abstract

Background: It is not known whether the number of revascularizations modifies clinical outcomes in patients with ischemic cardiomyopathy (ICM) implanted with cardiac resynchronization therapy defibrillator (CRT-D) vs. an implantable cardioverter-defibrillator (ICD)-only.

Methods: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), we evaluated the effect of CRT-D vs. ICD-only on heart failure (HF) or death, on ventricular tachycardia (VT), ventricular fibrillation (VF) or death, and on reverse remodeling in 592 ICM patients with left bundle branch block, by the number of pre-enrollment revascularizations (0, 1 or ≥ 2 revascularizations).

Results: There was a risk reduction of HF/death with CRT-D vs. ICD-only in all three sub-groups: ICM with no need for revascularization (HR 0.51 [0.26–1.02]; p = 0.055), ICM with 1 revascularization (HR 0.45 [0.30–0.70]; p < 0.001), and ICM with 2 or more revas­cularizations (HR 0.37 [0.20–0.66]; p < 0.001). Similarly, there was a risk reduction of VT/ /VF/death with CRT-D vs. ICD-only in patients with no need for revascularization (HR 0.55 [0.31–0.99]; p = 0.044); with 1 revascularization (HR 0.77 [0.51–1.18]; p = 0.23); or with ≥ 2 revascularizations (HR 0.63 [0.34–1.17]; p = 0.14). There was a similar degree of left ventricular reverse remodeling in all three subgroups (p > 0.05 for LVESV, LVEDV, and LAV percent change at 1-year follow-up).

Conclusions: In ICM patients, CRT-D is associated with a reduction in HF or death and VT/VF or death — irrespective of the frequency of pre-enrollment revascularization procedures — and is accompanied by a similar degree of beneficial left ventricular reverse remodeling.

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Keywords

cardiac resynchronization therapy, implantable cardioverter- -defibrillator, heart failure, ventricular tachyarrhythmias

About this article
Title

Effectiveness of cardiac resynchronization therapy by the frequency of revascularization procedures in ischemic cardiomyopathy patients

Journal

Cardiology Journal

Issue

Vol 23, No 4 (2016)

Pages

437-445

Published online

2016-06-16

DOI

10.5603/CJ.a2016.0032

Pubmed

27320956

Bibliographic record

Cardiol J 2016;23(4):437-445.

Keywords

cardiac resynchronization therapy
implantable cardioverter- -defibrillator
heart failure
ventricular tachyarrhythmias

Authors

Mustafa Husaini
Yitschak Biton
Brad Stair
Arthur J. Moss
Tor Biering-Sørensen
Scott Solomon
Scott McNitt
Bronislava Polonsky
Wojciech Zareba
Alon Barsheshet
Valentina Kutyifa

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