Key result
Adding CRT to sacubitril/valsartan in HFrEF linked to ~3-point greater LVEF improvement and fewer hospitalizations.
Why the study?
CRT is widely recommended for HFrEF patients with QRS duration > 150 msec, but its role in symptomatic patients on maximally tolerated sacubitril/valsartan with QRS duration of 130–149 msec remains debated.
Does adding cardiac resynchronization therapy (CRT) improve LV reverse remodeling and functional status in symptomatic HFrEF patients with LBBB and QRS duration 130–149 msec receiving maximally tolerated sacubitril/valsartan?
Cohort (n=100)
Does adding cardiac resynchronization therapy (CRT) improve LV reverse remodeling and functional status in symptomatic HFrEF patients with LBBB and QRS duration 130–149 msec receiving maximally tolerated sacubitril/valsartan?
In symptomatic HFrEF patients on sacubitril/valsartan with intermediate QRS prolongation (130–149 msec) and LBBB, adjunctive CRT significantly enhances LV reverse remodeling, improves NYHA functional class, and reduces hospitalizations at 6 months.
Answers are grounded in this paper and cite their sources.
May support CRT consideration in HFrEF with intermediate QRS on sacubitril/valsartan; leaves open confirmation in randomized trials.
Background Heart failure (HF) represents a substantial worldwide healthcare burden, with nearly 26 million people affected. CRT is widely recommended for HFrEF patients with QRS duration > 150 msec, but its role in those with QRS duration of 130–149 msec remains debated. The objective was to evaluate whether adding CRT improves LV reverse remodeling and functional status in symptomatic HFrEF patients receiving maximally tolerated sacubitril/valsartan with QRS duration of 130–149 msec. Methods This study included 100 patients with HFrEF (≤ 35%) treated with maximally tolerated sacubitril/valsartan and having LBBB morphology with QRS duration of 130–149 msec. Patients were classified into two groups: those receiving CRT and those maintained on medical therapy without CRT. Clinical status, QRS duration, and echocardiographic findings were reassessed after 6 months and compared between groups. Results At 6 months, NYHA class improvement occurred more frequently with CRT than without CRT (37 vs. 20 patients, P = 0.004). The decline in end-systolic volume was greater in the CRT group (mean change, 11.42 ± 7.30 vs. 3.54 ± 6.41, P < 0.001). Ejection fraction also showed greater improvement with CRT (mean change, 4.24 ± 3.17 vs. 1.30 ± 2.35, P < 0.001). Hospitalization occurred less frequently in the CRT group (46% vs. 70%, P = 0.03). No deaths were observed in either group throughout follow-up. Conclusions In symptomatic HFrEF patients receiving maximally tolerated sacubitril/valsartan with QRS duration of 130–149 msec, adjunctive CRT was associated with greater LV reverse remodeling, improved functional status, and fewer hospitalizations.
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Nazmy et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=100). Cardiac resynchronization therapy (CRT) added to sacubitril/valsartan vs. Medical therapy without CRT (maximally tolerated sacubitril/valsartan) was evaluated on Left ventricular reverse remodeling (decline in end-systolic volume and improvement in ejection fraction) and functional status (NYHA class improvement) (p=<0.001). Adding CRT to sacubitril/valsartan in HFrEF with QRS 130–149 ms improved LVEF (+4.24% vs +1.30%, P<0.001) and reduced hospitalizations (46% vs 70%, P=0.03).
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