Relationship between pre-implant ejection fraction and outcome after cardiac resynchronization therapy in symptomatic patients

• Published in: Acta cardiologica Vol. 69; no. 4; p. 424
• Main Authors: Schuchert, Andreas, Muto, Carmine, Maounis, Themistoklis, Ella, Rita Omega, Polauck, Alexander, Padeletti, Luigi
• Format: Journal Article
• Language: English
• Published: England 01.08.2014
• Subjects: Aged; Cardiac Resynchronization Therapy - methods; Defibrillators, Implantable; Female; Follow-Up Studies; France; Germany; Greece; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Italy; Male; Middle Aged; Pacemaker, Artificial; Single-Blind Method; Stroke Volume; Treatment Outcome; Ultrasonography
• ISSN: 0001-5385; 1784-973X
• DOI: 10.1080/AC.69.4.3036659

Left-ventricular ejection fraction (LVEF) is regarded as a strong predictor for morbidity and mortality in heart failure patients. The aim of the analysis was to assess the relationship between pre-implant LVEF and outcome of patients with advanced heart failure who received cardiac resynchronization therapy (CRT). We analysed the two-year follow-up of 366 patients who had been enrolled in the MASCOT study which included NYHA class III/IV patients with a class I CRT indication. Pre-implant LVEF was stratified by tertile. The boundaries for pre-implant LVEF were < 22% (n = 128; 18.2 +/- 3.1%; T(low)), 22% to 28% (n = 121; 25.4 +/- 1.4%; T(middle)) and > 28% (n = 117; 32.6 +/- 3.9%; T(high)) for each tertile.Two-year post-implant LVEF was 32.0 +/- 11.5% (T(low)), 33.7 +/- 10.8% (T(middle)) and 36.4 +/- 9.9% (T(high)). T(Iow) had a greater increase between pre- and post-implant LVEF compared to T(middle) (P = 0.03) and T(high) (P = 0.0001). NYHA class improved similarly among the three groups as well as the quality of life score. No significant differences were detected between the three groups for all-cause mortality, cardiac death, all-cause hospitalization, and hospitalization due to worsening heart failure. Symptomatic heart failure patients with a wide QRS complex and a severe impaired LV function had a better improvement of their pre-implant LVEF than patients with a more preserved LVEF. This may be one reason that in these patient groups long-term morbidity and mortality were not related to their pre-implant LVEF. Pre-implant LVEF was in symptomatic CRT patients not predictive for their long-term cardiovascular morbidity and mortality.