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

Alon Barsheshet, Ilan Goldenberg, Arthur J. Moss, Michael Eldar, David T. Huang, Scott McNitt, Helmut U. Klein, W. Jackson Hall, Mary W. Brown, Jeffrey J. Goldberger, Robert E. Goldstein, Claudio Schuger, Wojciech Zareba, James P. Daubert

Research output: Contribution to journalArticle

93 Scopus citations

Abstract

AimsThere 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 resultsThe 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.ConclusionMildly 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.

Original languageEnglish (US)
Pages (from-to)1622-1630
Number of pages9
JournalEuropean heart journal
Volume32
Issue number13
DOIs
StatePublished - Jul 1 2011
Externally publishedYes

Keywords

  • Cardiac resynchronization therapy
  • Heart failure
  • Ischaemic aetiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Response to preventive cardiac resynchronization therapy in patients with ischaemic and nonischaemic cardiomyopathy in MADIT-CRT'. Together they form a unique fingerprint.

  • Cite this

    Barsheshet, A., Goldenberg, I., Moss, A. J., Eldar, M., Huang, D. T., McNitt, S., Klein, H. U., Hall, W. J., Brown, M. W., Goldberger, J. J., Goldstein, R. E., Schuger, C., Zareba, W., & Daubert, J. P. (2011). Response to preventive cardiac resynchronization therapy in patients with ischaemic and nonischaemic cardiomyopathy in MADIT-CRT. European heart journal, 32(13), 1622-1630. https://doi.org/10.1093/eurheartj/ehq407