Cardiac resynchronisation therapy in patients with heart failure and a normal QRS duration: the RESPOND study. Issue 13 (21st February 2011)

• Record Type: Journal Article
• Authors: Foley, Paul W X; Patel, Kiran; Irwin, Nick; Sanderson, John E; Frenneaux, Michael P; Smith, Russell E A; Stegemann, Berthold; Leyva, Francisco
• Is Part Of: Heart. Volume 97:Issue 13(2011)
• Page Start: 1041
• Page End: 1047
• Publication Date: 2011-02-21
• Subjects: Cardiac resynchronisation therapy -- heart failure -- mortality -- normal QRS duration -- pacemakers -- cardiac remodelling -- cardiomyopathy dilated; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2010.208355
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: To evaluate the clinical response to cardiac resynchronisation therapy (CRT) in patients with heart failure and a normal QRS duration (<120 ms). Setting: Single centre. Patients: 60 patients with heart failure and a normal QRS duration receiving optimal pharmacological treatment (OPT). Interventions: Patients were randomly assigned to CRT (n=29) or to a control group (OPT, n=31). Cardiovascular magnetic resonance was used in order to avoid scar at the site of left ventricular (LV) lead deployment. Main outcome measures: The primary end point was a change in 6 min walking distance (6-MWD). Other measures included a change in quality of life scores (Minnesota Living with Heart Failure questionnaire) and New York Heart Association class. Results: In 93% of implantations, the LV lead was deployed over non-scarred myocardium. At 6 months, the 6-MWD increased with CRT compared with OPT (p<0.0001), with more patients reaching a ≥25% increase (51.7% vs 12.9%, p=0.0019). Compared with OPT, CRT led to an improvement in quality-of-life scores (p=0.0265) and a reduction in NYHA class (p<0.0001). The composite clinical score (survival for 6 months free of heart failure hospitalisations plus improvement by one or more NYHA class or by ≥25% in 6-MWD) was better in CRT than in OPT (83% vs 23%, respectively; p<0.0001). Although no differences in total or cardiovascular mortality emerged between OPT and CRT, patients receiving OPT had a higher risk of death from pump failure than patients assigned to CRT (HR=8.41, p=0.0447) after a median follow-up of 677.5 days. Conclusions: CRT leads to an improvement in symptoms, exercise capacity and quality of life in patients with heart failure and a normal QRS duration. (ClinicalTrials.gov number, NCT00480051 .)