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. 2009 Sep;30(18):2275-83.
doi: 10.1093/eurheartj/ehp226. Epub 2009 Jun 10.

Effectiveness of cardiac resynchronization therapy in heart failure patients with valvular heart disease: comparison with patients affected by ischaemic heart disease or dilated cardiomyopathy. The InSync/InSync ICD Italian Registry

Giuseppe Boriani  1 , Maurizio Gasparini, Maurizio Landolina, Maurizio Lunati, Mauro Biffi, Massimo Santini, Luigi Padeletti, Giulio Molon, Gianluca Botto, Tiziana De Santo, Sergio Valsecchi; InSync/InSync ICD Italian Registry Investigators
Collaborators, Affiliations

Effectiveness of cardiac resynchronization therapy in heart failure patients with valvular heart disease: comparison with patients affected by ischaemic heart disease or dilated cardiomyopathy. The InSync/InSync ICD Italian Registry

Giuseppe Boriani et al. Eur Heart J. 2009 Sep.

Abstract

Aims: To analyse the effectiveness of cardiac resynchronization therapy (CRT) in patients with valvular heart disease (a subset not specifically investigated in randomized controlled trials) in comparison with ischaemic heart disease or dilated cardiomyopathy patients.

Methods and results: Patients enrolled in a national registry were evaluated during a median follow-up of 16 months after CRT implant. Patients with valvular heart disease treated with CRT (n = 108) in comparison with ischaemic heart disease (n = 737) and dilated cardiomyopathy (n = 635) patients presented: (i) a higher prevalence of chronic atrial fibrillation, with atrioventricular node ablation performed in around half of the cases; (ii) a similar clinical and echocardiographic profile at baseline; (iii) a similar improvement of LVEF and a similar reduction in ventricular volumes at 6-12 months; (iv) a favourable clinical response at 12 months with an improvement of the clinical composite score similar to that occurring in patients with dilated cardiomyopathy and more pronounced than that observed in patients with ischaemic heart disease; (v) a long-term outcome, in term of freedom from death or heart transplantation, similar to patients affected by ischaemic heart disease and basically more severe than that of patients affected by dilated cardiomyopathy.

Conclusion: In 'real world' clinical practice, CRT appears to be effective also in patients with valvular heart disease. However, in this group of patients the outcome after CRT does not precisely overlap any of the two other groups of patients, for which much more data are currently available.

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Figures

Figure 1
Figure 1
Response to cardiac resynchronization therapy according to the clinical composite score in the whole patient population (A) or only in patients with NYHA functional class III–IV at baseline (B), according to the underlying heart disease.
Figure 2
Figure 2
Kaplan–Meier estimates of time to death from any cause in the whole patient population (A) or only in patients with NYHA functional class III–IV at baseline (B), according to the underlying heart disease.
See this image and copyright information in PMC

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