Cardiac resynchronization therapy for patients with mild to moderately reduced ejection fraction and left bundle branch block.

Autor:	Cha YM; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: ycha@mayo.edu., Lee HC; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Mulpuru SK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Deshmukh AJ; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Friedman PA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Asirvatham SJ; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Bradley DJ; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Madhavan M; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Abou Ezzeddine OF; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Wen S; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Liddell BW; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Curran C; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Li C; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota., Dasari S; Department of Biomedical Informatics, Mayo Clinic, Rochester, Minnesota., Lanza IR; Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota., Bailey KR; Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota., Chen HH; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2024 Nov; Vol. 21 (11), pp. 2250-2259. Date of Electronic Publication: 2024 May 19.
DOI:	10.1016/j.hrthm.2024.05.014
Abstrakt:	Background: It is unknown whether cardiac resynchronization therapy (CRT) would improve or halt the progression of heart failure (HF) in patients with mild to moderately reduced ejection fraction (HFmmrEF) and left bundle branch block (LBBB). Objective: This study aimed to investigate the outcomes of CRT in patients with HFmmrEF and left ventricular conduction delay. Methods: A prospective, randomized clinical trial sponsored by the National Heart, Lung, and Blood Institute included 76 patients who met the study inclusion criteria (left ventricular ejection fraction [LVEF] of 36%-50% and LBBB). Patients received CRT-pacemaker and were randomized to CRT-OFF (right ventricular pacing 40 beats/min) or CRT-ON (biventricular pacing 60-150 beats/min). At a 6-month follow-up, pacing programming was changed to the opposite settings. New York Heart Association class, N-terminal pro-brain natriuretic peptide levels, and echocardiographic variables were collected at baseline, 6 months, and 12 months. The primary study end point was the left ventricular end-systolic volume (LVESV) change from baseline, and the primary randomized comparison was the comparison of 6-month to 12-month changes between randomized groups. Results: The mean age of the patients was 68.4 ± 9.8 years (male, 71%). Baseline characteristics were similar between the 2 randomized groups (all P > .05). In patients randomized to CRT-OFF first, then CRT-ON, LVESV was reduced from baseline only after CRT-ON (baseline, 116.1 ± 36.5 mL; CRT-ON, 87.6 ± 26.0 mL; P < .0001). The randomized analysis of LVEF showed a significantly better change from 6 to 12 months in the OFF-ON group (P = .003). LVEF was improved by CRT (baseline, 41.3% ±.7%; CRT-ON, 46.0% ± 8.0%; P = .002). In patients randomized to CRT-ON first, then CRT-OFF, LVESV was reduced after both CRT-ON and CRT-OFF (baseline, 109.8 ± 23.5 mL; CRT-ON, 91.7 ± 30.5 mL [P < .0001]; CRT-OFF, 99.3 ± 28.9 mL [P = .012]). However, the LVESV reduction effect became smaller between CRT-ON and CRT-OFF (P = .027). LVEF improved after both CRT-ON and CRT-OFF (baseline, 42.7% ± 4.3%; CRT-ON, 48.5% ± 8.6% [P < .001]; CRT-OFF, 45.9% ± 7.7% [P = .025]). Conclusion: CRT for patients with HFmmrEF significantly improves LVEF and ventricular remodeling after 6 months of CRT. The study provides novel evidence that early CRT benefits patients with HFmmrEF with LBBB. Competing Interests: Disclosures The authors have no conflicts of interest to disclose. (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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