Do we have sufficient evidence for cardiac resynchronization therapy indication in patients with cardiac failure and NYHA functional classification I-II?

Authors: M. Táborský;  P. Heinc;  M. Fedorco
Authors‘ workplace: I. interní klinika, FN a LF Univerzity Palackého ;  Olomouc
Published in: Kardiol Rev Int Med 2010, 12(2): 80-83


Large scale clinical trials have demonstrated the effects of cardiac resynchronization therapy in patients with New York Heart Association (NYHA) class III/IV, systolic left ventricular function and QRS duration > 120 ms. Two recently published studies have demonstrated that the effects of cardiac resynchronization therapy might also be beneficial in patients with mild heart failure and NYHA class II. More clinical studies are needed to verify the long-term effects of cardiac resynchronization therapy on mortality reduction in this patient cohort.

cardiac resynchronization therapy – heart failure – mortality – reverse remodeling


1. Cazeau S, Leclerq C, Lavergne T et al. Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular delay. N Engl J Med 2001; 344: 873–880.

2. Gasparini M, Auricchio A, Regoli F et al. Four-year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation. J Am Cool Cardiol 2006; 48: 734–743.

3. Abraham WT, Fischer WG, Smith AL et al. MIRACLE Study Group. Multicenter InSync Randomized Clinical Evaluation. Cardiac resynchronization therapyin chronic heart failure. N Engl J Med 2002: 346; 1845–1853.

4. Moher D, Cook DJ, Eastwood S et al. Improving the quality of reports of meta-analyses of randomized controlled trials. The QUORUM statement. Quality of Reporting of Meta-analyses. Lancet 1999: 354; 1896 1900.

5. Beshai JF, Grimm RA, Nagueh SF et al. RethinQ Study Investigators. Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med 2007; 357: 2461–2471.

6. Bleecker GB, Holman ER, Steendijk P et al. Cardiac resynchronization therapy in patients with narrow QRS complex. J Am Coll Cardiol 2006; 48: 2243–2250.

7. Dickstein K, Cohen-Solal A, Filippatos G et al. ESC guidelines for the diagnosis and treatment of acute and chronic herat failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29: 2388–2442.

8. Vardas EP, Auricchio A, Balnc JJ et al. European Society of Cardiology; European Heart Rhythm Association. Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. Eur Heart J 2007; 28: 2256–2295.

9. Nelson GS, Berger RD, Fetics BJ et al. Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 2000; 102: 3053–3059.

10. St John Sutton MG, Plappert T, Abraham WT et al. Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study Group. Effect of cardiac resynchronization therapy of left ventricular size and function in chronic heart failure. Circulation 2003; 107: 1985–1990.

11. Yu CM, Bleecker GB, Fung JW et al. Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy. Circulation 2005; 112: 1580–1586.

12. Woo GW, Petersen-Stejskal S, Johnson JW et al. Ventricular reverse remodeling and 6-month outcomes in patients receiving cardiac resynchronization therapy: analysis of the MIRACLE Study. J Interv Card Electrophysiol 2005; 12: 107–113.

13. Higgins SL, Hummel JD, Niazi IK et al. Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias. J Am Coll Cardiol 2003; 42: 1454–1459.

14. Cleland JG, Daubert JC, Erdmann E et al. Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005: 352; 1539–1549.

15. Abraham WT, Young JB, León AR et al. Multicenter InSync ICD II Study Group. Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for a implantable cardioverter-defibrillator, and mildly symptomatic heart failure. Circulation 2004: 110; 2864–2868.

16. Bristow MR, Saxon LA, Boehmer J et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140–2150.

17. McAlister FA, Ezekowitz J, Hoorton N et al. Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: a systematic review. JAMA 2007; 297: 2502–2514.18. Daubert C, Gold MR, Abraham WT et al. REVERSE Study Group. Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction. insights from the European cohort of the REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial. J Am Coll Cardiol 2009; 54: 1837–1846.

19. Moss AJ, Hall WJ, Cannom DS et al. MADIT-CRT Trial Investigators. MADIT-CRT Trial Investigators. Cardiac- resynchronization therapy for the prevention of heart failure events. N Engl J Med 2009; 361: 1329–1338.

20. Tang T, Wells G. Resynchronization/defibrillation for ambulatory heart failure trial (RAFT). [http:/]

21. Landolina M, Lunati M, Gasparini M et al. InSync/ InSync ICD Italian Registry Investigators. Comparison of the effects of cardiac resynchronization therapy in patients with class II versus class III and IV heart failure (from the InSync/InSync ICD Italian Registry). Am J Cardiol 2007; 100: 1007–1012.

22. Špinar J, Hradec J, Meluzín J et al. Doporučení pro diagnostiku a léčbu chronického srdečního selhání ČKS 2006. Cor Vasa 2007; 49: K5–K41.

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