Abstract 8807: Cardiac Resynchronization Therapy Reduces Mortality and Hospitalization in Patients with Minimal Heart Failure: Specific Evidence on Asymptomatic (NYHA I) Patients
Background: Recent clinical trials suggest that cardiac resynchronization therapy (CRT) improves left ventricular function and clinical outcomes in patients with mild (New York Heart Association (NYHA) I-II) heart failure (HF). However, no individual trial had sufficient number of asymptomatic (NYHA I) patients to assess the CRT effect in this group. We tested the hypothesis that CRT benefits asymptomatic HF patients.
Methods: We performed a meta-analysis of randomized clinical trials comparing CRT vs. implantable cardioverter defibrillator (ICD) in patients with NYHA class I-II HF.
Results: We identified 5 trials (acronyms: RAFT (n=1438), MADIT-CRT (n=1820), REVERSE (n=610), MIRACLE-ICD II (n=186), CONTAK-CD (n=263) including 4,317 patients with NYHA class I-II HF. Average age of patients was 65 years, and 80% were male. Mean weighted follow-up was 2.4 years (range 6 to 40 months). CRT patients had a significantly greater improvement in ejection fraction (+5.9% vs. +2.2%, p<0.001). CRT was associated with significantly lower mortality and HF hospitalization among NYHA class II patients (RR=0.73; 95% CI (0.64-0.83), p<0.001) (Table). In asymptomatic (NYHA I) patients, HF hospitalization risk was lower (RR=0.57; 95% CI (0.34-0.97), p=0.04) with CRT, however, there was no difference in mortality (Table). Twelve asymptomatic (NYHA I) HF patients needed to be treated to prevent 1 hospitalization.
Conclusion: CRT decreases all-cause mortality, reduces HF hospitalizations, and improves left ventricular ejection fraction in asymptomatic and mildly symptomatic HF patients. These are the first data on CRT effects specifically in asymptomatic (NYHA I) HF patients.
- © 2011 by American Heart Association, Inc.