Navigation Links
Heart Failure: Targeting the right patients for CRT-D
Date:5/22/2011

Patients with dyssynchronous yet viable ventricles are most likely to benefit from cardiac resynchronization therapy combined with defibrillation, concludes the latest analysis of the MADIT CRT trial. The CRT-MADIT-CRT trial - presented at the Heart Failure Congress 2011, organized by the Heart Failure Association of the European Society of Cardiology (ESC) in Late Breaking Session 1 - showed that CRT produced improvements in both synchrony and contractile function, and that the extent of this benefit relates to subsequent outcomes.

The Multicentre Automatic Defibrillator Implantation Trial-CRT (MADIT-CRT) set out to determine whether patients with mild heart failure (NYHA class I or II) would do better if they got implanted with a CRT-D device (which combines cardiac resynchronization therapy with defibrillation), than if they only received the traditional ICD defibrillation. In earlier studies CRT-D devices had been approved for use in patients with severe heart failure (NYHA class III/IV).

In the MADIT-CRT study, funded by Boston Scientific, 1820 patients with Class I and II heart failure, wide QRS and left ventricular dysfunction were randomized 3:2 to receive CRT-D (n=1089) or ICD alone (n=731). Results, presented at the 2009 ESC Annual Conference in Barcelona after a follow period averaging 2.4 years, demonstrated a greater than 40% reduction in the primary endpoint of death or heart failure in patients receiving CRT-D. However, in virtually all studies of CRT-D approximately 30% of patients do not respond to therapy.

In the current study, Dr Scott D Solomon (Brigham and Women's Hospital, Boston, MA) and colleagues set out to investigate whether the degree of synchrony the extent to which the walls of the left ventricle contract in unison might influence the likelihood of patients responding to CRT-D. "It's important to target patients in whom CRT-D works well because the technology is quite expensive," explained Solomon.

In this latest analysis of MADIT-CRT, investigators analyzed echocardiograms from 1077 patients enrolled in MADIT-CRT (CRT-D n=66; ICD, n=416) who had echocardiographic images of sufficient quality to allow analysis of synchrony and contractile function. Researchers were blinded to the randomization and study outcomes.

Results showed that patients with mild to moderate dyssynchrony at baseline (defined as a time-to peak transverse strain SD of 142-230 ms) and greater baseline contractile function (longitudinal strain < -8.7%) improved to a greater extent when randomised to the CRT-D group than the ICD only group.

The study showed that over a year each 10 ms decrease in LV dyssynchrony was associated with a 3% reduction in the primary outcome of death or heart failure, and each 5 point absolute increase in LV strain was associated with a 75% reduction in the primary outcome.

"These results suggest that the patients who are most likely to benefit from CRT-D are those with at least some dyssynchrony who have relatively preserved contractile function," said Solomon, adding that the observation that improvements in synchrony and contractile function were associated with reduced death and heart failure events, suggests that the benefits delivered by CRT relate to improvements in these factors. "Future studies will continue to try to identify the patients who are most likely to benefit from this expensive but highly effective therapy," he said.


'/>"/>

Contact: Jacqueline Partarrieu
press@escardio.org
33-492-947-756
European Society of Cardiology
Source:Eurekalert

Related biology news :

1. Dark chocolate: Half a bar per week to keep at bay the risk of heart attack
2. NIH awards Clemson bioengineer $1.5 million to improve durability of tissue heart valves
3. Researchers study how pistachios may improve heart health
4. Argonne scientists peer into heart of compound that may detect chemical, biological weapons
5. LIAI launches new division to look at novel approaches to heart disease and inflammation
6. Study provides insight on a common heart rhythm disorder
7. Embryonic heart exhibits impressive regenerative capacity
8. Repair in the developing heart
9. Drug-embedded microparticles bolster heart function in animal studies
10. Heart valves that grow with the patient
11. Research uncovers new steps on pathway to enlarged heart
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:12/6/2016)... , Dec. 6, 2016 Valencell , the ... it has seen a third consecutive year of triple ... technology in 2016 with a 360 percent increase in ... This increase was driven by sales of its wrist ... interest in its technology for hearables for fitness and ...
(Date:11/30/2016)... and WARSAW, Poland , Nov. 30, 2016 Not many ... of the most crucial aspects of recovery so we need to do it well. ... risks, including heart problems, high blood pressure, stroke, diabetes, and even cancer. ... and find a Christmas present that could help them to manage their sleep quality? ... ...
(Date:11/28/2016)... 28, 2016 "The biometric ... 16.79%" The biometric system market is in the ... the near future. The biometric system market is expected ... at a CAGR of 16.79% between 2016 and 2022. ... biometric technology in smartphones, rising use of biometric technology ...
Breaking Biology News(10 mins):
(Date:12/9/2016)... ... ... DuPont Industrial Biosciences (DuPont) and Archer Daniels Midland Company ... Platts Global Energy for their platform technology to produce a revolutionary biobased ... Platts Global Energy Awards, held in New York on Thursday, Dec. 8. , ...
(Date:12/9/2016)... , Dec. 9, 2016 /PRNewswire/ - Portage Biotech Inc. ... PBT.U), is pleased to announce that Biohaven has issued ... New Haven, Connecticut (PRWEB) Dec 9, 2016 ... "Biohaven") announced today that the U.S. Food and Drug ... request covering its drug candidate BHV-0223, an orally dissolving ...
(Date:12/8/2016)... Medical Incorporated ("OncoSec") (NASDAQ: ONCS ), ... announced financial results for the fiscal first quarter ... our commitment to address an unmet medical need ... with the early clinical response data presented from ... on advancing our lead program – ImmunoPulse® IL-12 ...
(Date:12/8/2016)... MOINES, Iowa , Dec. 8, 2016 Eurofins announces ... US Food and President of Eurofins Scientific Inc. (ESI). ... Division with his proven professional and entrepreneurial experience in leading international ... in the US food testing market to uphold Eurofins, status as ... ...
Breaking Biology Technology: