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The effects of aetiology on outcome in patients treated with cardiac resynchronization therapy in the CARE-HF trial.

Wikstrom G, Blomström-Lundqvist C, Andren B, Lönnerholm S, Blomström P, Freemantle N, Remp T, Cleland JG, CARE-HF study investigato - Eur. Heart J. (2009)

Bottom Line: Left ventricular ejection fraction and left ventricular end-systolic volume improved to a lesser extent in the IHD group (4.53 vs. 8.50% and -35.68 vs. -58.52 cm(3)).Despite these differences, CRT improved all-cause mortality, NYHA class, and hospitalization rates to a similar extent in patients with or without IHD.The benefits of CRT in patients with or without IHD were similar in relative terms in the CARE-HF study but as patients with IHD had a worse prognosis, the benefit in absolute terms may be greater.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Institute of Medical Sciences, Akademiska Hospital, University of Uppsala, Uppsala, Sweden. gerhard.wikstrom@medsci.uu.se

ABSTRACT

Aims: Cardiac dyssynchrony is common in patients with heart failure, whether or not they have ischaemic heart disease (IHD). The effect of the underlying cause of cardiac dysfunction on the response to cardiac resynchronization therapy (CRT) is unknown. This issue was addressed using data from the CARE-HF trial.

Methods and results: Patients (n = 813) were grouped by heart failure aetiology (IHD n = 339 vs. non-IHD n = 473), and the primary composite (all-cause mortality or unplanned hospitalization for a major cardiovascular event) and principal secondary (all-cause mortality) endpoints analysed. Heart failure severity and the degree of dyssynchrony were compared between the groups by analysing baseline clinical and echocardiographic variables. Patients with IHD were more likely to be in NYHA class IV (7.5 vs. 4.0%; P = 0.03) and to have higher NT-proBNP levels (2182 vs. 1725 pg/L), indicating more advanced heart failure. The degree of dyssynchrony was more pronounced in patients without IHD (assessed using mean QRS duration, interventricular mechanical delay, and aorta-pulmonary pre-ejection time). Left ventricular ejection fraction and left ventricular end-systolic volume improved to a lesser extent in the IHD group (4.53 vs. 8.50% and -35.68 vs. -58.52 cm(3)). Despite these differences, CRT improved all-cause mortality, NYHA class, and hospitalization rates to a similar extent in patients with or without IHD.

Conclusion: The benefits of CRT in patients with or without IHD were similar in relative terms in the CARE-HF study but as patients with IHD had a worse prognosis, the benefit in absolute terms may be greater.

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Related in: MedlinePlus

Hazard ratio and 95% confidence interval for ischaemic and non-ischaemic subgroups, primary outcome, and all-cause mortality.
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EHN577F1: Hazard ratio and 95% confidence interval for ischaemic and non-ischaemic subgroups, primary outcome, and all-cause mortality.

Mentions: Clinical outcome variables measured during the study at 18 months’ follow-up are presented in Table 3. Mean QRS duration at 18 months was shortened and quality of life and NYHA class were improved by CRT in both patient groups. There was a trend for a greater effect of CRT on the primary outcome measure of all-cause mortality and cardiovascular hospitalization, in patients without IHD (hazard ratio 0.48; 95% CI 0.35–0.65) when compared with those with IHD (hazard ratio 0.72; 95% CI 0.54–0.95) (Table 4, Figures 1 and 2). However, the interaction term comparing these two hazard functions was not statistically significant, indicating that the apparent difference could plausibly be explained by chance (P = 0.06). The effect of CRT on all-cause mortality was very similar [hazard ratio 0.60 (95% CI 0.42–0.86) and 0.59 (95% CI 0.37–0.92) for IHD and no IHD, respectively].


The effects of aetiology on outcome in patients treated with cardiac resynchronization therapy in the CARE-HF trial.

Wikstrom G, Blomström-Lundqvist C, Andren B, Lönnerholm S, Blomström P, Freemantle N, Remp T, Cleland JG, CARE-HF study investigato - Eur. Heart J. (2009)

Hazard ratio and 95% confidence interval for ischaemic and non-ischaemic subgroups, primary outcome, and all-cause mortality.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2663726&req=5

EHN577F1: Hazard ratio and 95% confidence interval for ischaemic and non-ischaemic subgroups, primary outcome, and all-cause mortality.
Mentions: Clinical outcome variables measured during the study at 18 months’ follow-up are presented in Table 3. Mean QRS duration at 18 months was shortened and quality of life and NYHA class were improved by CRT in both patient groups. There was a trend for a greater effect of CRT on the primary outcome measure of all-cause mortality and cardiovascular hospitalization, in patients without IHD (hazard ratio 0.48; 95% CI 0.35–0.65) when compared with those with IHD (hazard ratio 0.72; 95% CI 0.54–0.95) (Table 4, Figures 1 and 2). However, the interaction term comparing these two hazard functions was not statistically significant, indicating that the apparent difference could plausibly be explained by chance (P = 0.06). The effect of CRT on all-cause mortality was very similar [hazard ratio 0.60 (95% CI 0.42–0.86) and 0.59 (95% CI 0.37–0.92) for IHD and no IHD, respectively].

Bottom Line: Left ventricular ejection fraction and left ventricular end-systolic volume improved to a lesser extent in the IHD group (4.53 vs. 8.50% and -35.68 vs. -58.52 cm(3)).Despite these differences, CRT improved all-cause mortality, NYHA class, and hospitalization rates to a similar extent in patients with or without IHD.The benefits of CRT in patients with or without IHD were similar in relative terms in the CARE-HF study but as patients with IHD had a worse prognosis, the benefit in absolute terms may be greater.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Institute of Medical Sciences, Akademiska Hospital, University of Uppsala, Uppsala, Sweden. gerhard.wikstrom@medsci.uu.se

ABSTRACT

Aims: Cardiac dyssynchrony is common in patients with heart failure, whether or not they have ischaemic heart disease (IHD). The effect of the underlying cause of cardiac dysfunction on the response to cardiac resynchronization therapy (CRT) is unknown. This issue was addressed using data from the CARE-HF trial.

Methods and results: Patients (n = 813) were grouped by heart failure aetiology (IHD n = 339 vs. non-IHD n = 473), and the primary composite (all-cause mortality or unplanned hospitalization for a major cardiovascular event) and principal secondary (all-cause mortality) endpoints analysed. Heart failure severity and the degree of dyssynchrony were compared between the groups by analysing baseline clinical and echocardiographic variables. Patients with IHD were more likely to be in NYHA class IV (7.5 vs. 4.0%; P = 0.03) and to have higher NT-proBNP levels (2182 vs. 1725 pg/L), indicating more advanced heart failure. The degree of dyssynchrony was more pronounced in patients without IHD (assessed using mean QRS duration, interventricular mechanical delay, and aorta-pulmonary pre-ejection time). Left ventricular ejection fraction and left ventricular end-systolic volume improved to a lesser extent in the IHD group (4.53 vs. 8.50% and -35.68 vs. -58.52 cm(3)). Despite these differences, CRT improved all-cause mortality, NYHA class, and hospitalization rates to a similar extent in patients with or without IHD.

Conclusion: The benefits of CRT in patients with or without IHD were similar in relative terms in the CARE-HF study but as patients with IHD had a worse prognosis, the benefit in absolute terms may be greater.

Show MeSH
Related in: MedlinePlus