February 11, 2010European Journal of Heart Failure125 citationsOpen Access

Cardiac Resynchronization Therapy May Benefit Patients with Left Ventricular Ejection Fraction 35%: A PROSPECT Trial Substudy

ECEugene ChungChrist Hospital RKRodolphe P. KatraMedtronic (United States)SGStefano GhioHeart Failure & Transplant

Structured PICO

Does Cardiac resynchronization therapy (CRT) improve clinical and structural outcomes in patients with LVEF >35% comparably to those with LVEF <35%?

Population

361 patients enrolled in the PROSPECT trial who received CRT, with NYHA Class III-IV status and QRS >130 ms.

Intervention

Cardiac resynchronization therapy (CRT) in patients with core laboratory-measured LVEF >35% (OVER35)

Comparator

Cardiac resynchronization therapy (CRT) in patients with core laboratory-measured LVEF <35% (UNDER35)

Outcome

Clinical composite score (CCS) and change in LV end systolic volume (LVESV) from baseline to 6-month follow-upcomposite

Patients with LVEF >35%, NYHA Class III-IV, and QRS >130 ms may derive comparable clinical and structural benefit from CRT as those with LVEF <35%.

Abstract

AIMS: Cardiac resynchronization therapy (CRT) is currently limited to those with left ventricular ejection fraction (LVEF) 35% might benefit from CRT, we performed a retrospective analysis of the predictors of response to CRT (PROSPECT) database. METHODS AND RESULTS: PROSPECT was a prospective, multicentre study that enrolled CRT patients based on enrolling centre-evaluated LVEF 35% (OVER35) were compared with those whose LVEF was 35%. At entry, OVER35 had smaller LV volumes, shorter QRS duration, shorter 6-min walk distance, and were more likely to have ischaemic aetiology than UNDER35. Outcomes were comparable between the groups, with 62.8% of OVER35 improved in CCS (70.2% in UNDER35) and 50.8% of OVER35 improved in LVESV (57.8% in UNDER35). CONCLUSION: Patients with LVEF >35%, New York heart association functional Class III-IV status, and QRS >130 ms appear to derive clinical and structural benefit from CRT. As CRT may offer a valuable option for these patients, this hypothesis should be formally tested in a prospective, randomized multicentre trial.

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