Cardiac resynchronisation therapy significantly increased 6-minute walking distance compared with optimal pharmacological treatment, with 51.7% vs 12.9% achieving a ≥25% increase (P=0.0019).
RCT (n=60)
randomly assigned
No
Does cardiac resynchronisation therapy improve 6-minute walking distance in patients with heart failure and a normal QRS duration?
In a small single-center trial, CRT improved exercise capacity, symptoms, and quality of life in heart failure patients with a normal QRS duration compared to optimal pharmacological treatment alone.
p-value: p=<0.0001
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.).
Foley et al. (Mon,) conducted a rct in heart failure and a normal QRS duration (<120 ms) (n=60). Cardiac resynchronisation therapy (CRT) vs. optimal pharmacological treatment (OPT) was evaluated on change in 6 min walking distance (6-MWD) (p=<0.0001). Cardiac resynchronisation therapy significantly increased 6-minute walking distance compared with optimal pharmacological treatment, with 51.7% vs 12.9% achieving a ≥25% increase (P=0.0019).