PMID- 20797487
OWN - NLM
STAT- MEDLINE
DCOM- 20100917
LR  - 20100827
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 56
IP  - 10
DP  - 2010 Aug 31
TI  - Critical appraisal of the use of cardiac resynchronization therapy beyond current 
      guidelines.
PG  - 754-62
LID - 10.1016/j.jacc.2010.04.035 [doi]
AB  - Cardiac resynchronization therapy (CRT) is an effective treatment for patients 
      with drug-refractory, chronic heart failure. Multiple single-center and 
      multicenter studies have shown significant reductions in left ventricular (LV) 
      volumes and an increase in LV systolic function. More importantly, CRT reduces 
      mortality and morbidity during long-term follow-up. Current guidelines consider 
      CRT as a Class I indication for heart failure patients in New York Heart 
      Association (NYHA) functional class III to IV with depressed LV ejection fraction 
      <or=35% and a wide QRS complex (>or=120 ms). However, the benefits of this 
      therapy could possibly be extended to selected subgroups of patients who do not 
      fulfill these criteria. These subgroups include patients with mildly symptomatic 
      heart failure and patients with a narrow QRS complex (<120 ms). Results from 
      recent multicenter controlled clinical trials including heart failure patients in 
      NYHA functional class I to II or with a narrow QRS complex are equivocal. 
      Although expanding CRT to patients with a narrow QRS complex seems currently not 
      likely, the benefits of CRT in mildly symptomatic patients are more evident. 
      Perhaps attenuation of disease progression will prove to be a successful new 
      treatment strategy in heart failure patients in the future. In addition, 
      multimodality cardiac imaging will allow optimizing responder rate in patients 
      undergoing CRT according to current guidelines.
CI  - Copyright (c) 2010 American College of Cardiology Foundation. Published by 
      Elsevier Inc. All rights reserved.
FAU - Van Bommel, Rutger J
AU  - Van Bommel RJ
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Delgado, Victoria
AU  - Delgado V
FAU - Schalij, Martin J
AU  - Schalij MJ
FAU - Bax, Jeroen J
AU  - Bax JJ
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - Aged
MH  - *Cardiac Pacing, Artificial
MH  - Electrocardiography
MH  - Female
MH  - Heart Failure/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Practice Guidelines as Topic
MH  - Ventricular Dysfunction, Left/therapy
MH  - Ventricular Remodeling/physiology
RF  - 53
EDAT- 2010/08/28 06:00
MHDA- 2010/09/21 06:00
CRDT- 2010/08/28 06:00
PHST- 2009/11/13 00:00 [received]
PHST- 2010/03/30 00:00 [revised]
PHST- 2010/04/06 00:00 [accepted]
PHST- 2010/08/28 06:00 [entrez]
PHST- 2010/08/28 06:00 [pubmed]
PHST- 2010/09/21 06:00 [medline]
AID - S0735-1097(10)02299-0 [pii]
AID - 10.1016/j.jacc.2010.04.035 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2010 Aug 31;56(10):754-62. doi: 10.1016/j.jacc.2010.04.035.