Impact of Cardiac Resynchronization Therapy on Exercise Performance, Functional Capacity, and Quality of Life in Systolic Heart Failure With QRS Prolongation: COMPANION Trial Sub-Study

Autor: Jerry D. Kennett, Jalal K. Ghali, Leslie A. Saxon, John P. Boehmer, Michael B. Higginbotham, Brian D. Lowes, Michael R. Bristow, Satish Goel, Eugene E. Wolfel, Philip C. Kirlin, Elizabeth Galle, Fred Ecklund, David E. Mann, Teresa De Marco, Lynne E. Wagoner, Arthur M. Feldman, Patrick Yong
Rok vydání: 2008
Předmět:
Male
Pacemaker
Artificial
medicine.medical_specialty
Vital capacity
Defibrillation
medicine.medical_treatment
Cardiac resynchronization therapy
Severity of Illness Index
law.invention
Electrocardiography
QRS complex
Randomized controlled trial
Reference Values
law
Internal medicine
medicine
Humans
cardiovascular diseases
Aged
Probability
Exercise Tolerance
Ejection fraction
Ventricular Remodeling
medicine.diagnostic_test
business.industry
Stroke Volume
Middle Aged
medicine.disease
Combined Modality Therapy
Survival Analysis
Defibrillators
Implantable
Treatment Outcome
Heart failure
Heart Function Tests
Multivariate Analysis
Quality of Life
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Heart Failure
Systolic
circulatory and respiratory physiology
Zdroj: Journal of Cardiac Failure. 14:9-18
ISSN: 1071-9164
DOI: 10.1016/j.cardfail.2007.08.003
Popis: A total of 405 participants in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure trial were prospectively enrolled in an exercise sub-study designed to study the influence of cardiac resynchronization therapy (CRT) on measures of exercise capacity, functional capacity, and quality of life (QOL).Substudy eligibility included New York Heart Association (NYHA) functional Class III or IV heart failure, left ventricular ejection fractionor =0.35, QRS interval ofor =120 ms, normal sinus rhythm, a heart failure hospitalization (or equivalent) within 1 year, a peak VO2or =22 mL x kg x min, the ability to walk 150 to 425 meters in 6 minutes, forced expiratory volume in 1 second/forced vital capacityor =50%, and no clinical indication for a pacemaker or implantable cardioverter-defibrillator. Patients were randomized in a 1:4 ratio to optimal medical therapy (OPT) or to OPT plus CRT. Cardiopulmonary exercise testing (peak VO2 and 6-minute walk distance [6MWD]) and assessment of NYHA functional class and QOL were assessed at baseline and at 3 and 6 months of assigned therapy. There was no significant improvement in peak VO2 at 6 months in the CRT group compared with the OPT group (+0.63 mL x kg x min) by unadjusted analysis (P = .05) or by analyses adjusted for missing data. Thus the primary end point of the study was not met. There was significantly greater improvement in the 6MWD in the CRT group compared with the OPT group at both 3 and 6 months by both statistical methods (Por = .045). Likewise, a greater proportion of CRT patients improved by 1 or more NYHA functional classes (P.01) at 3 months and had better QOL scores (P.01) at 3 and 6 months compared with the OPT patients. Baseline peak VO2 predicted clinical events (time to death, time to death or first hospitalization, or time to death and first heart failure hospitalization: P.05) in CRT participants.CRT patients with moderate to advanced symptoms of systolic heart failure and prolonged QRS intervals benefit from the addition of CRT to OPT in terms of exercise capacity, functional status, and QOL. CRT should be considered standard therapy in this select group of heart failure patients.
Databáze: OpenAIRE
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