Featured Research

from universities, journals, and other organizations

Heart Failure: Targeting the right patients for CRT-D

Date:
May 22, 2011
Source:
European Society of Cardiology
Summary:
Patients with dyssynchronous yet viable ventricles are most likely to benefit from cardiac resynchronization therapy combined with defibrillation, concludes the latest analysis of the MADIT CRT trial.

Patients with dyssynchronous yet viable ventricles are most likely to benefit from cardiac resynchronization therapy combined with defibrillation, concludes the latest analysis of the MADIT CRT trial. The CRT-MADIT-CRT trial -- presented at the Heart Failure Congress 2011, organized by the Heart Failure Association of the European Society of Cardiology (ESC) in Late Breaking Session 1 -- showed that CRT produced improvements in both synchrony and contractile function, and that the extent of this benefit relates to subsequent outcomes.

Related Articles


The Multicentre Automatic Defibrillator Implantation Trial-CRT (MADIT-CRT) set out to determine whether patients with mild heart failure (NYHA class I or II) would do better if they got implanted with a CRT-D device (which combines cardiac resynchronization therapy with defibrillation), than if they only received the traditional ICD defibrillation. In earlier studies CRT-D devices had been approved for use in patients with severe heart failure (NYHA class III/IV).

In the MADIT-CRT study, funded by Boston Scientific, 1820 patients with Class I and II heart failure, wide QRS and left ventricular dysfunction were randomized 3:2 to receive CRT-D (n=1089) or ICD alone (n=731). Results, presented at the 2009 ESC Annual Conference in Barcelona after a follow period averaging 2.4 years, demonstrated a greater than 40% reduction in the primary endpoint of death or heart failure in patients receiving CRT-D. However, in virtually all studies of CRT-D approximately 30% of patients do not respond to therapy.

In the current study, Dr Scott D Solomon (Brigham and Women's Hospital, Boston, MA) and colleagues set out to investigate whether the degree of synchrony -- the extent to which the walls of the left ventricle contract in unison -- might influence the likelihood of patients responding to CRT-D. "It's important to target patients in whom CRT-D works well because the technology is quite expensive," explained Solomon.

In this latest analysis of MADIT-CRT, investigators analyzed echocardiograms from 1077 patients enrolled in MADIT-CRT (CRT-D n=66; ICD, n=416) who had echocardiographic images of sufficient quality to allow analysis of synchrony and contractile function. Researchers were blinded to the randomization and study outcomes.

Results showed that patients with mild to moderate dyssynchrony at baseline (defined as a time-to peak transverse strain SD of 142-230 ms) and greater baseline contractile function (longitudinal strain < -8.7%) improved to a greater extent when randomised to the CRT-D group than the ICD only group.

The study showed that over a year each 10 ms decrease in LV dyssynchrony was associated with a 3% reduction in the primary outcome of death or heart failure, and each 5 point absolute increase in LV strain was associated with a 75% reduction in the primary outcome.

"These results suggest that the patients who are most likely to benefit from CRT-D are those with at least some dyssynchrony who have relatively preserved contractile function," said Solomon, adding that the observation that improvements in synchrony and contractile function were associated with reduced death and heart failure events, suggests that the benefits delivered by CRT relate to improvements in these factors. "Future studies will continue to try to identify the patients who are most likely to benefit from this expensive but highly effective therapy," he said.


Story Source:

The above story is based on materials provided by European Society of Cardiology. Note: Materials may be edited for content and length.


Cite This Page:

European Society of Cardiology. "Heart Failure: Targeting the right patients for CRT-D." ScienceDaily. ScienceDaily, 22 May 2011. <www.sciencedaily.com/releases/2011/05/110522141556.htm>.
European Society of Cardiology. (2011, May 22). Heart Failure: Targeting the right patients for CRT-D. ScienceDaily. Retrieved October 31, 2014 from www.sciencedaily.com/releases/2011/05/110522141556.htm
European Society of Cardiology. "Heart Failure: Targeting the right patients for CRT-D." ScienceDaily. www.sciencedaily.com/releases/2011/05/110522141556.htm (accessed October 31, 2014).

Share This



More Health & Medicine News

Friday, October 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Fauci Says Ebola Risk in US "essentially Zero"

Fauci Says Ebola Risk in US "essentially Zero"

AP (Oct. 30, 2014) NIAID Director Anthony Fauci said the risk of Ebola becoming an epidemic in the U.S. is essentially zero Thursday at the Washington Ideas Forum. He also said an Ebola vaccine will be tested in West Africa in the next few months. (Oct. 30) Video provided by AP
Powered by NewsLook.com
Nurse Defies Ebola Quarantine With Bike Ride

Nurse Defies Ebola Quarantine With Bike Ride

AP (Oct. 30, 2014) A nurse who vowed to defy Maine's voluntary quarantine for health care workers who treated Ebola patients followed through on her promise Thursday, leaving her home for an hour-long bike ride. (Oct. 30) Video provided by AP
Powered by NewsLook.com
Pot-Infused Edibles Raise Concerns in Colorado

Pot-Infused Edibles Raise Concerns in Colorado

AFP (Oct. 30, 2014) Colorado may have legalized marijuana for recreational use, but the debate around the decision still continues, with a recent - failed - attempt to ban cannabis-infused edibles. Duration: 01:53 Video provided by AFP
Powered by NewsLook.com
British Navy Ship Arrives in Sierra Leone With Ebola Aid

British Navy Ship Arrives in Sierra Leone With Ebola Aid

AFP (Oct. 30, 2014) The British ship RFA ARGUS arrived in Sierra Leone to deliver supplies and equipment to help the fight against Ebola. Duration: 00:42 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins