PMID- 16797091
OWN - NLM
STAT- MEDLINE
DCOM- 20070404
LR  - 20071115
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 115
IP  - 2
DP  - 2007 Feb 7
TI  - Suboptimal medical therapy in patients with systolic heart failure is associated 
      with less improvement by cardiac resynchronization therapy.
PG  - 214-9
AB  - BACKGROUND: Proven medical therapy is under-prescribed in heart failure (HF) for 
      various reasons. Cardiac resynchronization therapy (CRT) is of proven value in 
      selected patients with HF; however, the degree of benefit in those without the 
      optimal therapy is not clear. METHODS: This is a retrospective study comparing 
      the effect of CRT in 30 patients without optimal combination therapy (group 1; 10 
      (33%) without ACEi or equivalent and 25 (83%) without beta-blockers) to an age, 
      sex, ejection fraction (EF) and New York Heart Association (NYHA) class matched 
      control but with the combination (group 2; n=30) at baseline. All patients were 
      in NYHA class III or IV with EF < or = 35% and QRS interval > or = 120 ms. 
      Echocardiographic examination and N-terminal pro-brain natriuretic peptide (NT 
      pro-BNP) levels before and 3 months after CRT were compared between the two 
      groups. The composite endpoints of HF hospitalization or death during follow-up 
      were compared by Kaplan-Meier analysis. RESULTS: There were significantly less 
      improvement in EF (+4.0+/-2.5% vs +10.1+/-3.2%; p<0.05) and degree of reverse 
      remodeling in group 1 after 3 months. Patients in group 1 had significantly 
      higher level of NT pro-BNP levels at 3 months (2221+/-2001 pg/mL vs 1038+/-905 
      pg/mL; p<0.001) and higher rates of HF hospitalization or death (53.3% vs 23.3%; 
      Log rank chi2 5.52; p=0.019). CONCLUSION: Patients receiving CRT but without 
      optimal medical therapy were associated with less echocardiographic and clinical 
      improvement. Optimal medical therapy, if tolerated, before CRT is necessary.
FAU - Fung, Jeffrey W H
AU  - Fung JW
AD  - Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales 
      Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China. 
      jwhfung@cuhk.edu.hk
FAU - Chan, Joseph Y S
AU  - Chan JY
FAU - Kum, Leo C C
AU  - Kum LC
FAU - Chan, Hamish C K
AU  - Chan HC
FAU - Yip, Gabriel W K
AU  - Yip GW
FAU - Zhang, Q
AU  - Zhang Q
FAU - Yu, Cheuk M
AU  - Yu CM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20060621
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
SB  - IM
MH  - Aged
MH  - Combined Modality Therapy
MH  - *Electric Countershock
MH  - Female
MH  - Heart Failure/drug therapy/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Systole
EDAT- 2006/06/27 09:00
MHDA- 2007/04/05 09:00
CRDT- 2006/06/27 09:00
PHST- 2005/09/28 00:00 [received]
PHST- 2006/03/13 00:00 [revised]
PHST- 2006/04/01 00:00 [accepted]
PHST- 2006/06/27 09:00 [pubmed]
PHST- 2007/04/05 09:00 [medline]
PHST- 2006/06/27 09:00 [entrez]
AID - S0167-5273(06)00396-2 [pii]
AID - 10.1016/j.ijcard.2006.04.034 [doi]
PST - ppublish
SO  - Int J Cardiol. 2007 Feb 7;115(2):214-9. doi: 10.1016/j.ijcard.2006.04.034. Epub 
      2006 Jun 21.