Clinical predictors and timing of New York Heart Association class improvement with cardiac resynchronization therapy in patients with advanced chronic heart failure: Results from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE-ICD) trials

• Published in: The American heart journal Vol. 151; no. 4; pp. 837 - 843
• Main Authors: Pires, Luis A., Abraham, William T., Young, James B., Johnson, Katrina M.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2006; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Blood pressure; Cardiac Pacing, Artificial; Cardiology. Vascular system; Defibrillators, Implantable; Electric Countershock; Female; Heart; Heart failure; Heart Failure - physiopathology; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Logistic Models; Male; Medical research; Medical sciences; Middle Aged; Pacemaker, Artificial; Patients; Randomized Controlled Trials as Topic; Retrospective Studies; Treatment Outcome; Ventricular Function, Left; New York; United States; North America; America; Heart; Human; Heart failure; Cardiac resynchronization; Evaluation; Predictor; Multicenter study; Prediction; Instrumentation therapy; Cardiovascular disease; Result; Improvement; Chronic; Randomization; Association; Heart disease; Clinical trial; Timing; Predictive factor
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2005.06.024

Based on current patient selection criteria, a significant proportion of recipients of cardiac resynchronization therapy (CRT) do not respond to treatment. The purpose of this analysis is to identify predictors and characterize the timing of response to CRT in patients with advanced heart failure. Patients randomized to receive CRT in the MIRACLE and MIRACLE-ICD trials, designed to assess the benefit of CRT compared with standard medical therapy in patients with advanced heart failure, left ventricular ejection fraction <0.35, and QRS ≥130 milliseconds, were included for this analysis. Patients with an improvement of ≥1 New York Heart Association (NYHA) class from baseline to the 6-month follow-up were considered responders and those who had no change or worse NYHA class or died were classified as nonresponders. Responders were subdivided into early (within 1-3 months) and late (6 months). One hundred forty-three (64%) of 224 and 190 (61%) of 313 patients in the MIRACLE and MIRACLE-ICD trials, respectively, responded to therapy, with 81 (57%) of 143 and 100 (53%) of 190 responding early. Several but differing factors predicted CRT response and timing in the two trials with a high sensitivity (89%-90%) but, owing to a low specificity (31%-49%), a modest predictive accuracy (66%-75%). Based on improvement of ≥1 NYHA class, less than two thirds of patients enrolled in the MIRACLE or MIRACLE-ICD trials responded to CRT, with just more than half responding within the first month. Several factors predicted CRT response and timing, but given their modest predictive accuracy, comparable for both studies, additional methods for selecting candidates most likely to benefit from CRT are needed.