PMID- 20842565
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20110714
LR  - 20211020
IS  - 1534-3189 (Electronic)
IS  - 1092-8464 (Linking)
VI  - 12
IP  - 5
DP  - 2010 Oct
TI  - Cardiac resynchronization therapy in asymptomatic or mildly symptomatic heart 
      failure patients.
PG  - 431-42
LID - 10.1007/s11936-010-0089-2 [doi]
AB  - Heart failure is a constantly progressing disease involving patients with 
      ischemic and nonischemic cardiac disease. Cardiac resynchronization therapy (CRT) 
      has been used successfully in patients with severe heart failure symptoms, poor 
      left ventricular (LV) function, and a prolonged QRS duration. Large trials in 
      patients with New York Heart Association (NYHA) class III/IV heart failure have 
      demonstrated that heart failure symptoms can be reduced and exercise capacity 
      improved, overall mortality decreased, and ventricular function increased. How 
      long these beneficial effects of CRT will last in patients with an already 
      advanced stage of heart failure, particularly in NYHA IV, is still unknown. 
      Therefore, it is more reasonable to initiate CRT in appropriate patients who have 
      structural heart disease but have not yet developed severe heart failure 
      symptoms. Slowing heart failure progression seems to be the most important 
      target. Medical treatment alone has not demonstrated that this can be achieved in 
      patients with poor ventricular function and prolonged QRS (>120 ms). The recently 
      published results of MADIT-CRT, as well as the extended follow-up of the REVERSE 
      substudy of the European patient cohort, have shown that prevention of heart 
      failure progression can be well accomplished with CRT and implantable 
      cardioverter-defibrillator (ICD) backup (CRT-D). Heart failure events and death 
      occurred significantly less often in patients with CRT-D than in those with an 
      ICD only. A clinically important reversal of ventricular remodeling with reduced 
      ventricular volumes and increased LV ejection fraction was found in the 
      CRT-D-treated patients. The benefit was seen in patients with ischemic and 
      nonischemic cardiomyopathy and in those with NYHA class I or II heart failure; 
      the most benefit was demonstrated in patients showing a "classic" left bundle 
      branch block electrocardiogram pattern (about 70% of the enrolled patients) and 
      in female patients. Results from both trials support the view that future efforts 
      regarding heart failure treatment should concentrate more on prevention of heart 
      failure progression in mildly symptomatic or even asymptomatic candidates for 
      CRT-D. It is time to change the guidelines for heart failure treatment.
FAU - Klein, Helmut U
AU  - Klein HU
AD  - University of Rochester Medical Center, Heart Research Follow-up Program, 601 
      Elmwood Avenue, Box 653, Rochester, NY, 14642, USA, 
      helmut.klein@heart.rochester.edu.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Curr Treat Options Cardiovasc Med
JT  - Current treatment options in cardiovascular medicine
JID - 9815942
EDAT- 2010/09/16 06:00
MHDA- 2010/09/16 06:01
CRDT- 2010/09/16 06:00
PHST- 2010/09/16 06:00 [entrez]
PHST- 2010/09/16 06:00 [pubmed]
PHST- 2010/09/16 06:01 [medline]
AID - 10.1007/s11936-010-0089-2 [doi]
PST - ppublish
SO  - Curr Treat Options Cardiovasc Med. 2010 Oct;12(5):431-42. doi: 
      10.1007/s11936-010-0089-2.