Cardiac-Resynchronization Therapy in Heart Failure With Narrow QRS Complexes
Topic: Arrhythmias
Clinical Trial: yes
Study Question: Is cardiac resynchronization therapy (CRT) of clinical benefit in heart failure (HF) patients with ventricular dyssynchrony and QRS duration <130 ms?
Methods: A biventricular implantable cardioverter defibrillator (ICD) with CRT was implanted in 172 patients (mean age, 59 years) with class III HF, ejection fraction (EF) <35%, QRS duration <130 ms, After baseline evaluation including cardiopulmonary exercise testing, the patients were randomly assigned to CRT (n = 87) or a control group without CRT (n = 85). The patients were re-evaluated at 6 months. endpoint was the proportion of patients with a ≥1.0 ml/kg/min increase in peak oxygen consumption during exercise testing at 6 months.
Results: Endpoint between the CRT group (46%) and the control group (41%). There also were no significant differences between the two groups in quality-of-life scores, the 6-minute walk test, echocardiographic parameters, or survival. Subgroup analysis demonstrated a significant improvement in peak oxygen consumption in the CRT group with QRS duration of 120-130 ms.
Conclusions: There is no objective evidence of clinical benefit from CRT among patients with a narrow QRS who have ventricular dyssynchrony.
Perspective: Approximately 30% of patients with HF, EF <35%, and a narrow QRS complex have evidence of mechanical dyssynchrony, and prior nonrandomized cohort studies have reported that these patients may benefit from CRT. The present study is important because it demonstrates that CRT does not improve functional capacity or quality-of-life in patients with a QRS duration <120 ms, at least with the current techniques used to identify and quantitate mechanical dyssynchrony. Fred Morady, M.D., F.A.C.C.
QRS综合狭窄的心律衰竭的患者进行心脏再同步治疗
话题：心律失常
临床试验：有
方法：一个两心室的ICD通过CRT被移入到了172名患者体内，这些患者平均年龄在59岁，HF III，排泄功能EF<35%，QRS段<130 ms。在基线测评包括与心肺有关的检测后，有87名患者被随机分到了CRT组，有85名患者被分到了control group但没CRT。在6个月的时间里，病人又再一次接受检查，≥1.0 ml/kg/min病人终点的氧气耗量已经达到一个最高点。
结果：CRT group 终点为46%，the control group为41%。两个小组的基本生活条件分数，6分钟步行测验，心电图参数或幸存概率等没有什么不同。小组分析证明，对于QRS段120-130 ms的CRT小组的氧气消耗最高点是一个很有意义的完善。
结论：对于狭窄QRS并且有心室异常同步病人进行CRT，没有什么客观凭上能够从临床上获取益处。
观点：Fred Morady, M.D., F.A.C.C.认为，大约有30%的HF病人, EF <35%，狭窄QRS已有异常同步的迹象，先前的非随机性群组织研究已经报道了这些病人可能从CRT中得到益处。目前的研究很重要，因为它证明了CRT在QRS段<120 ms病人没有完善功能或提高基本生活指数，至少目前的技术习惯于识别和测定mechanical dyssynchrony。
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