Effects of Cardiac Resynchronization on Disease Progression in Patients With Left Ventricular Systolic Dysfunction, an Indication for an Implantable Cardioverter-Defibrillator, and Mildly Symptomatic Chronic Heart Failure

• William T. Abraham

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• James B. Young

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• Angel R. León

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• Stuart Adler

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• Alan J. Bank

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• Shelley A. Hall

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• Randy Lieberman

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• L. Bing Liem

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• John B. O’Connell

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• John S. Schroeder

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

• Kevin R. Wheelan

  From the Ohio State University Heart Center, Columbus (W.T.A.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Emory University-Crawford Long Hospital, Atlanta, Ga (A.R.L.); St Paul Heart Clinic, St Paul, Minn (A.J.B., S.A.); Baylor Heart and Vascular Hospital, Dallas, Tex (S.A.H., K.R.W.); Harper University Hospital-Wayne State University, Detroit, Mich (J.B.O., R.L.); and Stanford University, Palo Alto, Calif (L.B.L., J.S.S.).

抄録

Background— The effects of cardiac resynchronization therapy (CRT) in patients with mildly symptomatic heart failure have not been fully elucidated. Methods and Results— The Multicenter InSync ICD Randomized Clinical Evaluation II (MIRACLE ICD II) was a randomized, double-blind, parallel-controlled clinical trial of CRT in NYHA class II heart failure patients on optimal medical therapy with a left ventricular (LV) ejection fraction ≤35%, a QRS ≥130 ms, and a class I indication for an ICD. One hundred eighty-six patients were randomized: 101 to the control group (ICD activated, CRT off) and 85 to the CRT group (ICD activated, CRT on). End points included peak V̇ o 2 , V̇ e /V̇ co 2 , NYHA class, quality of life, 6-minute walk distance, LV volumes and ejection fraction, and composite clinical response. Compared with the control group at 6 months, no significant improvement was noted in peak V̇ o 2 , yet there were significant improvements in ventricular remodeling indexes, specifically LV diastolic and systolic volumes ( P =0.04 and P =0.01, respectively), and LV ejection fraction ( P =0.02). CRT patients showed statistically significant improvement in V̇ e /V̇ co 2 ( P =0.01), NYHA class ( P =0.05), and clinical composite response ( P =0.01). No significant differences were noted in 6-minute walk distance or quality of life scores. Conclusions— In patients with mild heart failure symptoms on optimal medical therapy with a wide QRS complex and an ICD indication, CRT did not alter exercise capacity but did result in significant improvement in cardiac structure and function and composite clinical response over 6 months.

収録刊行物

• Circulation

  Circulation 110 (18), 2864-2868, 2004-11-02

  Ovid Technologies (Wolters Kluwer Health)

キーワード

• Physiology (medical)
• Cardiology and Cardiovascular Medicine

詳細情報

• CRID: 1363107370535716480
• NII論文ID: 30022671097
• DOI: 10.1161/01.cir.0000146336.92331.d1
• ISSN: 15244539
• ISSN: 00097322
• ISSN: http://id.crossref.org/issn/00097322
• Web Site: https://www.ahajournals.org/doi/full/10.1161/01.CIR.0000146336.92331.D1
• データソース種別:
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