Key result
Cardiac resynchronization therapy significantly reduced systemic ventricular volume index (from 139 to 118 ml/m2, P=0.04) and improved BNP and NYHA class in congenital heart disease patients.
Why the study?
Does cardiac resynchronization therapy improve hemodynamics and functional status in patients with congenital heart disease and various systemic ventricular morphologies?
Observational (n=20)
Does cardiac resynchronization therapy improve hemodynamics and functional status in patients with congenital heart disease and various systemic ventricular morphologies?
p-value: p=0.04
CRT improves late hemodynamic and functional status in congenital heart disease patients with systemic left or single ventricles, but acute CRT effects do not guarantee long-term reverse remodeling in those with a systemic right ventricle.
Supports hemodynamic benefits of CRT in CHD with systemic LV or single ventricle; leaves open long-term remodeling in systemic RV pending randomized trials.
BACKGROUND: Cardiac resynchronization therapy (CRT) can result in functional improvement and reduced mortality in patients with medically refractory heart failure. Although CRT is reportedly effective in patients with congenital heart disease (CHD), it is still controversial in patients who have systemic right ventricle. METHODS AND RESULTS: Twenty CHD patients treated with CRT since 2006 were divided into 3 groups based on systemic ventricular (sysV) morphology (7 with left ventricle [sLV], 7 with right ventricle [sRV], and 6 with unbalanced 2 ventricles as a single-ventricular physiology [sBV]). The acute effects of CRT on hemodynamics and sysV function before device implantation was retrospectively evaluated and the chronic (≥6 months) effects of CRT on late outcomes was assessed. In our CHD populations, sysV volume index was reduced from 139±41 to 118±33 ml/m(2)(P=0.04) after CRT, and there was significant improvement in B-type natriuretic peptide levels (from 341±384 to 160±152 pg/ml, P=0.01) and New York Heart Association (NYHA) functional class (from 2.1±0.6 to 1.8±0.7, P=0.02) on a late outcome. The sRV group did not show a late sysV volume reduction despite significant QRS shortening, and an increase of sysV peak dP/dt in the acute study differed from that of other groups. CONCLUSIONS: CRT improves late hemodynamic and functional status in sLV and sBV CHD patients with a dyssynchronized sysV. However, an acute CRT effect cannot guarantee long-term benefit in sRV patients.
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Sakaguchi et al. (2015) conducted an observational in Congenital heart disease (n=20). Cardiac resynchronization therapy vs. Baseline was evaluated on Systemic ventricular volume index (p=0.04). Cardiac resynchronization therapy significantly reduced systemic ventricular volume index (from 139 to 118 ml/m2, P=0.04) and improved BNP and NYHA class in congenital heart disease patients.
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