Background The aim of the analysis was to compare theoutcome of heart failure patients in New York HeartAssociation (NYHA) class IV to that of NYHA class IIIpatients 1 year after implantation of a CRT device.Methods The analysis was based on the 405 CRT patientsenrolled in the MASCOT trial. At enrollment, 350 patients(86 %) were in NYHA class III and 55 (14 %) were inNYHA class IV.Results At 1-year follow-up, the improvement of theejection fraction was not statistically significantly differentbetween NYHA class III (?7.6 ± 11.7 %) and NYHAclass IV patients (?9.2 ± 14.2 %; p = 0.78). NYHA classIV patients had a better mean NYHA class reductionwith -1.93 ± 0.83 than NYHA class III patients with -0.93 ± 0.70 (p\0.0001). There was a greater meanquality of life improvement in NYHA class IV (-27.2 ±20.9) compared to NYHA class III (-17.7 ± 23.9;p = 0.02). All-cause mortality as well as cardiac mortalityremained higher in NYHA class IV with 25.5 and 16.4 %than in NYHA class III with 7.1 and 3.1 % (p\0.0001).Conclusions In this study, 14 % of all patients receiving aCRT device had NYHA class IV at implantation. The datasupport the concept to implant a CRT device in NYHAclass IV patients, because at 1 year after implantation, theyexperienced better symptomatic improvement compared toNYHA class III patients. The higher cardiac as well as noncardiacmortality resulted in a fivefold higher all-causemortality compared to NYHA class III patients.

One-year outcome after CRT implantation in NYHA class IV in comparison to NYHA class III patients.

CALVI V;
2013-01-01

Abstract

Background The aim of the analysis was to compare theoutcome of heart failure patients in New York HeartAssociation (NYHA) class IV to that of NYHA class IIIpatients 1 year after implantation of a CRT device.Methods The analysis was based on the 405 CRT patientsenrolled in the MASCOT trial. At enrollment, 350 patients(86 %) were in NYHA class III and 55 (14 %) were inNYHA class IV.Results At 1-year follow-up, the improvement of theejection fraction was not statistically significantly differentbetween NYHA class III (?7.6 ± 11.7 %) and NYHAclass IV patients (?9.2 ± 14.2 %; p = 0.78). NYHA classIV patients had a better mean NYHA class reductionwith -1.93 ± 0.83 than NYHA class III patients with -0.93 ± 0.70 (p\0.0001). There was a greater meanquality of life improvement in NYHA class IV (-27.2 ±20.9) compared to NYHA class III (-17.7 ± 23.9;p = 0.02). All-cause mortality as well as cardiac mortalityremained higher in NYHA class IV with 25.5 and 16.4 %than in NYHA class III with 7.1 and 3.1 % (p\0.0001).Conclusions In this study, 14 % of all patients receiving aCRT device had NYHA class IV at implantation. The datasupport the concept to implant a CRT device in NYHAclass IV patients, because at 1 year after implantation, theyexperienced better symptomatic improvement compared toNYHA class III patients. The higher cardiac as well as noncardiacmortality resulted in a fivefold higher all-causemortality compared to NYHA class III patients.
2013
CRT implantation; Severe end-stage heart failure; Quality of life score
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11769/16867
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