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Previous Volume 352:1539-1549 April 14, 2005 Number 15 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Jarcho, J. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Cardiac resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We evaluated its effects on morbidity and mortality.

Methods Patients with New York Heart Association class III or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony who were receiving standard pharmacologic therapy were randomly assigned to receive medical therapy alone or with cardiac resynchronization. The primary end point was the time to death from any cause or an unplanned hospitalization for a major cardiovascular event. The principal secondary end point was death from any cause.

Results A total of 813 patients were enrolled and followed for a mean of 29.4 months. The primary end point was reached by 159 patients in the cardiac-resynchronization group, as compared with 224 patients in the medical-therapy group (39 percent vs. 55 percent; hazard ratio, 0.63; 95 percent confidence interval, 0.51 to 0.77; P<0.001). There were 82 deaths in the cardiac-resynchronization group, as compared with 120 in the medical-therapy group (20 percent vs. 30 percent; hazard ratio 0.64; 95 percent confidence interval, 0.48 to 0.85; P<0.002). As compared with medical therapy, cardiac resynchronization reduced the interventricular mechanical delay, the end-systolic volume index, and the area of the mitral regurgitant jet; increased the left ventricular ejection fraction; and improved symptoms and the quality of life (P<0.01 for all comparisons).

Conclusions In patients with heart failure and cardiac dyssynchrony, cardiac resynchronization improves symptoms and the quality of life and reduces complications and the risk of death. These benefits are in addition to those afforded by standard pharmacologic therapy. The implantation of a cardiac-resynchronization device should routinely be considered in such patients.

Source Information

From the Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom (J.G.F.C.); the Department of Cardiology, Hôpital Pontchaillou, Rennes, France (J.-C.D.); Klinik III für Innere Medizin der Universität zu Köln, Cologne, Germany (E.E.); the University of Birmingham, Edgbaston, United Kingdom (N.F.); Nouvelles Cliniques Nantaises, Nantes, France (D.G.); the Division of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (L.K.); and Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy (L.T.).

This article was published at www.nejm.org on March 7, 2004.

Address reprint requests to Dr. Cleland at the Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston-upon-Hull, United Kingdom, or at j.g.cleland{at}hull.ac.uk.

Full Text of this Article

Related Letters:

Cardiac-Resynchronization Therapy in Heart Failure
Kirkorian G. A., Burri H., Cleland J. G.F., Daubert J.-C., Tavazzi L., the CARE-HF Study Investigators
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N Engl J Med 2005; 353:205-206, Jul 14, 2005. Correspondence

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