PMID- 17826388
OWN - NLM
STAT- MEDLINE
DCOM- 20071101
LR  - 20071115
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 100
IP  - 6
DP  - 2007 Sep 15
TI  - Comparison of the effects of cardiac resynchronization therapy in patients with 
      class II versus class III and IV heart failure (from the InSync/InSync ICD 
      Italian Registry).
PG  - 1007-12
AB  - Cardiac resynchronization therapy (CRT) is recommended for patients with New York 
      Heart Association (NYHA) class III or IV heart failure and wide QRS complexes. 
      The aim of this study was to compare the effects of CRT in patients in NYHA class 
      II with those in NYHA class III or IV. Nine hundred fifty-two patients (188 in 
      NYHA class II) consecutively implanted with biventricular devices and enrolled in 
      a national observational registry were studied. Clinical outcomes were estimated 
      after 12 months of CRT, and long-term survival was assessed. At a median 
      follow-up of 16 months, significantly fewer major cardiovascular events were 
      reported in patients in NYHA class II compared with NYHA class III or IV (rate 13 
      vs 23 per 100 patient-years of follow-up, p<0.001). The percentage of patients 
      who improved in NYHA class status after 12 months of CRT was lower in those in 
      class II than in those in class III or IV (34% vs 69%, p<0.001), whereas the 
      absolute increase in the ejection fraction was similar (8+/-9% vs 9+/-11%, p=NS), 
      as well as the reductions in end-diastolic diameter (-3+/-8 vs -3+/-8 mm, p=NS) 
      and end-systolic diameter (-4+/-10 vs -6+/-10 mm, p=NS). The NYHA class II group 
      experienced lower all-cause mortality (log-rank test p=0.018). In the 2 groups, 
      patients with major cardiovascular events during follow-up exhibited less or no 
      reverse remodeling compared with those with better long-term clinical outcomes. 
      In conclusion, the results of this study indicate that CRT induced similar 
      improvements in ventricular function in the 2 groups, whereas the improvement in 
      functional status was significantly lower for patients in NYHA class II than for 
      those in class III or IV. A positive effect of CRT on cardiac dimensions was 
      associated with a long-term beneficial effect on disease progression in patients 
      in NYHA class II.
FAU - Landolina, Maurizio
AU  - Landolina M
AD  - Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy. 
      elettrofisiologia@smatteo.pv.it
FAU - Lunati, Maurizio
AU  - Lunati M
FAU - Gasparini, Maurizio
AU  - Gasparini M
FAU - Santini, Massimo
AU  - Santini M
FAU - Padeletti, Luigi
AU  - Padeletti L
FAU - Achilli, Augusto
AU  - Achilli A
FAU - Bianchi, Stefano
AU  - Bianchi S
FAU - Laurenzi, Francesco
AU  - Laurenzi F
FAU - Curnis, Antonio
AU  - Curnis A
FAU - Vincenti, Antonio
AU  - Vincenti A
FAU - Valsecchi, Sergio
AU  - Valsecchi S
FAU - Denaro, Alessandra
AU  - Denaro A
CN  - InSync/InSync ICD Italian Registry Investigators
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20070705
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Aged
MH  - *Cardiac Pacing, Artificial/mortality
MH  - Disease Progression
MH  - Female
MH  - Heart Failure/mortality/physiopathology/*therapy
MH  - Humans
MH  - Italy
MH  - Male
MH  - Middle Aged
MH  - Pacemaker, Artificial
MH  - Recovery of Function
MH  - Registries
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/physiopathology
MH  - Ventricular Remodeling
EDAT- 2007/09/11 09:00
MHDA- 2007/11/02 09:00
CRDT- 2007/09/11 09:00
PHST- 2007/01/18 00:00 [received]
PHST- 2007/04/13 00:00 [revised]
PHST- 2007/04/13 00:00 [accepted]
PHST- 2007/09/11 09:00 [pubmed]
PHST- 2007/11/02 09:00 [medline]
PHST- 2007/09/11 09:00 [entrez]
AID - S0002-9149(07)01180-0 [pii]
AID - 10.1016/j.amjcard.2007.04.043 [doi]
PST - ppublish
SO  - Am J Cardiol. 2007 Sep 15;100(6):1007-12. doi: 10.1016/j.amjcard.2007.04.043. 
      Epub 2007 Jul 5.