Follow up modalities significantly improve the efficacy of cardiac resynchronization therapy in patients with congestive heart failure

Abstract

Background: Cardiac resynchronization therapy (CRT) is a new definite therapy for patients (pts) with heart failure due to systolic dysfunction that are symptomatic even on optimal pharmacological therapy. Aim: Evaluate the efficacy of CRT regarding clinical and functional parameters, reduction in the number of hospitalizations and improvement in the quality of life (QOL). Methods: 37 pts (26 males, mean age 63±8) with a diagnosis of idiopathic dilated cardiomyopathy (19 pts) or ischemic, QRS duration > 130 msec, sinus rhythm, EF < 30%, NYHA III or IV after optimal therapy underwent CRT. All pts were evaluated by NYHA class, six minute walking test (6 WT), QOL questionnaire (Minnesota QOL score, 0-105), ecg, echocardiographic parameters and the number of hospitalizations during the past and successive year after CRT. Follow up data was obtained at 3, 6 and 12 months. All pts were followed in a HF ambulatory. Results: There was a significant improvement in QRS duration, EF, end systolic volume, NYHA class, 6WT and the quality of life (see table). All pts showed a reduction in hospitalizations (7.5±4.3 vs 3.3±2.3 days) and a reduction in their length (9.6 vs 4.1 days). During the follow up period β blocker dosage was increased (carvedilol 18.4±16.4 vs 29.8±18.3 mg p<.01) as so ACE inhibitor therapy (ramipril 4.1±2.7 vs 6.9±3.2 mg p<.01), and there was a reduction in diuretic administration (furosemide 98.8±64.4 vs 61.9±47.3 mg p<.01). Table 1 Conclusion: Our data showed that CRT permits to obtain improvement in clinical and functional parameters and reduction of hospitalizations. In pts undergoing CRT and followed in a HF ambulatory it is possible to optimize pharmacological therapy, in particular an increase in β blocker dosage. It is possible that the improvements seen are due to synergic actions of CRT, optimization of pharmacological therapy and follow up modalities.