MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy): cardiac resynchronization therapy towards early management of heart failure
Key result
This commentary discusses the rationale for evaluating cardiac resynchronization therapy in patients with less severe heart failure, noting prior trials included 86-94% NYHA class III patients.
Why the study?
Does cardiac resynchronization therapy improve outcomes in patients with less severe heart failure?
Population
Patients with heart failure, left ventricular dysfunction, and a prolonged QRS complex, specifically…
Design
Editorial
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
AJArthur J. MossProfessor of Medicine, University of Rochester Medical Center
“Cardiac resynchronisation therapy was dramatically effective in this large study population, with a 34% reduction in the risk of all-cause mortality or heart failure. The benefit is dominated by a 41% reduction in heart failure events. This results validate a new indication for cardiac resynchronisation therapy in the prevention of heart failure in at-risk asymptomatic or mildly symptomatic cardiac patients. It seems likely that this preventive CRT-D therapy will have widespread application and utilisation.”
RPRichard PagePresident, Heart Rhythm Society
“This is a very important trial. Previous studies have shown that the ICD saves lives. This trial demonstrates that in this population, an ICD with biventricular pacing can be expected also to improve clinical outcome as measured by hospitalization for heart failure. I anticipate that these results may improve acceptance of ICD therapy, both by patients and their physicians, in that the patient would not only live longer, but also would live better.”
AJArthur J. MossProfessor of Medicine, University of Rochester Medical Center
“The findings from MADIT-CRT show that CRT-D effectively reduces the risk of heart failure. There is a very large population of patients with heart disease whom we believe will benefit from CRT-D therapy.”
Implication
This commentary discusses the rationale for extending cardiac resynchronization therapy to patients with less severe heart failure, as investigated in the MADIT-CRT trial.
Key Points
- To discuss the role of cardiac resynchronization therapy in managing heart failure among patients with different NYHA classes.
- Analysis of randomized clinical trials like COMPANION and CARE-HF focusing on CRT efficacy in heart failure patients.
- Comparison of patient demographics in CRT trials vs. ICD trials.
- CRT improves symptoms and reduces hospitalizations in NYHA class III and IV heart failure patients.
- Evidence suggests CRT may also benefit patients with less severe heart failure based on its cardiac remodeling effects.
Structured PICO
Does cardiac resynchronization therapy improve outcomes in patients with less severe heart failure?
P
Population
Patients with heart failure, left ventricular dysfunction, and a prolonged QRS complex, specifically focusing on those with less severe heart failure (NYHA class I-II).
I
Intervention
Cardiac resynchronization therapy (CRT)
This commentary discusses the rationale for extending cardiac resynchronization therapy to patients with less severe heart failure, as investigated in the MADIT-CRT trial.
Cite This Study
Günter Breithardt (2009) conducted an editorial in Heart failure. Cardiac resynchronization therapy was evaluated. This commentary discusses the rationale for evaluating cardiac resynchronization therapy in patients with less severe heart failure, noting prior trials included 86-94% NYHA class III patients.