Cardiac Resynchronization Therapy: Who Benefits?

Background: Cardiac resynchronization therapy (CRT) has been well established in multiple large trials to improve symptoms, hospitalizations, reverse remodeling, and mortality in well-selected patients with heart failure when used in addition to optimal medical therapy. Updated consensus guidelines...

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Autores principales:	Jason S. Chinitz, Andre d'Avila, Martin Goldman, Vivek Reddy, Srinivas Dukkipati
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2014
Materias:	biventricular pacing cardiac resynchronization therapy cardiomyopathy dyssynchrony heart failure implantable cardioverter defibrillator Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/431a71bf02084a4398874f3e3de0b6df
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spelling	oai:doaj.org-article:431a71bf02084a4398874f3e3de0b6df2021-12-02T02:55:12ZCardiac Resynchronization Therapy: Who Benefits?2214-999610.1016/j.aogh.2013.12.003https://doaj.org/article/431a71bf02084a4398874f3e3de0b6df2014-04-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/79https://doaj.org/toc/2214-9996Background: Cardiac resynchronization therapy (CRT) has been well established in multiple large trials to improve symptoms, hospitalizations, reverse remodeling, and mortality in well-selected patients with heart failure when used in addition to optimal medical therapy. Updated consensus guidelines outline patients in whom such therapy is most likely to result in substantial benefit. However, pooled data have demonstrated that only approximately 70% of patients who qualify for CRT based on current indications actually respond favorably. In addition, current guidelines are based on outcomes from the carefully selected patients enrolled in clinical trials, and almost certainly fail to include all patients who might benefit from CRT. Findings: The identification of patients most likely to benefit from CRT requires consideration of factors beyond these standard criteria, QRS morphology with particular consideration in patients with left bundle-branch block pattern, extent of QRS prolongation, etiology of cardiomyopathy, rhythm, and whether the patient requires or will eventually need antibradycardia pacing. In addition, the baseline severity of functional impairment may influence the type of benefit to be expected from CRT; for example, New York Heart Association class I patients may derive long-term benefit in cardiac structure and function, but no benefit in symptoms or hospitalizations can be reasonably expected. In contrast, certain New York Heart Association class IV patients may be too sick to realize long-term mortality benefits from CRT, but improvements in hemodynamic profile and functional capacity may represent vital advances in this population. Conclusion: This review evaluates the evidence regarding the various factors that can predict positive or even detrimental responses to CRT, to help better determine who benefits most from this evolving therapy.Jason S. ChinitzAndre d'AvilaMartin GoldmanVivek ReddySrinivas DukkipatiUbiquity Pressarticlebiventricular pacingcardiac resynchronization therapycardiomyopathydyssynchronyheart failureimplantable cardioverter defibrillatorInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 80, Iss 1, Pp 61-68 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	biventricular pacing cardiac resynchronization therapy cardiomyopathy dyssynchrony heart failure implantable cardioverter defibrillator Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	biventricular pacing cardiac resynchronization therapy cardiomyopathy dyssynchrony heart failure implantable cardioverter defibrillator Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Jason S. Chinitz Andre d'Avila Martin Goldman Vivek Reddy Srinivas Dukkipati Cardiac Resynchronization Therapy: Who Benefits?
description	Background: Cardiac resynchronization therapy (CRT) has been well established in multiple large trials to improve symptoms, hospitalizations, reverse remodeling, and mortality in well-selected patients with heart failure when used in addition to optimal medical therapy. Updated consensus guidelines outline patients in whom such therapy is most likely to result in substantial benefit. However, pooled data have demonstrated that only approximately 70% of patients who qualify for CRT based on current indications actually respond favorably. In addition, current guidelines are based on outcomes from the carefully selected patients enrolled in clinical trials, and almost certainly fail to include all patients who might benefit from CRT. Findings: The identification of patients most likely to benefit from CRT requires consideration of factors beyond these standard criteria, QRS morphology with particular consideration in patients with left bundle-branch block pattern, extent of QRS prolongation, etiology of cardiomyopathy, rhythm, and whether the patient requires or will eventually need antibradycardia pacing. In addition, the baseline severity of functional impairment may influence the type of benefit to be expected from CRT; for example, New York Heart Association class I patients may derive long-term benefit in cardiac structure and function, but no benefit in symptoms or hospitalizations can be reasonably expected. In contrast, certain New York Heart Association class IV patients may be too sick to realize long-term mortality benefits from CRT, but improvements in hemodynamic profile and functional capacity may represent vital advances in this population. Conclusion: This review evaluates the evidence regarding the various factors that can predict positive or even detrimental responses to CRT, to help better determine who benefits most from this evolving therapy.
format	article
author	Jason S. Chinitz Andre d'Avila Martin Goldman Vivek Reddy Srinivas Dukkipati
author_facet	Jason S. Chinitz Andre d'Avila Martin Goldman Vivek Reddy Srinivas Dukkipati
author_sort	Jason S. Chinitz
title	Cardiac Resynchronization Therapy: Who Benefits?
title_short	Cardiac Resynchronization Therapy: Who Benefits?
title_full	Cardiac Resynchronization Therapy: Who Benefits?
title_fullStr	Cardiac Resynchronization Therapy: Who Benefits?
title_full_unstemmed	Cardiac Resynchronization Therapy: Who Benefits?
title_sort	cardiac resynchronization therapy: who benefits?
publisher	Ubiquity Press
publishDate	2014
url	https://doaj.org/article/431a71bf02084a4398874f3e3de0b6df
work_keys_str_mv	AT jasonschinitz cardiacresynchronizationtherapywhobenefits AT andredavila cardiacresynchronizationtherapywhobenefits AT martingoldman cardiacresynchronizationtherapywhobenefits AT vivekreddy cardiacresynchronizationtherapywhobenefits AT srinivasdukkipati cardiacresynchronizationtherapywhobenefits
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Cardiac Resynchronization Therapy: Who Benefits?

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