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European Journal of Heart Failure 2008 10(8):796-801; doi:10.1016/j.ejheart.2008.06.013
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© 2008 European Society of Cardiology

Very long term follow-up of cardiac resynchronization therapy: Clinical outcome and predictors of mortality

Mads Brix Kronborg*, Peter Thomas Mortensen, Rikke Esberg Kirkfeldt and Jens Cosedis Nielsen

Aarhus University Hospital Skejby, Denmark

* Corresponding author. Department of Cardiology B, Århus University Hospital, Braendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark. Tel.: +45 89 49 62 34; fax: +45 89 49 60 02. E-mail address: MADS.BRIX.KRONBORG{at}KI.AU.DK (M. B. Kronborg).


  Abstract

Background: Cardiac resynchronization therapy (CRT) improves symptoms, left ventricular ejection fraction (LVEF) and survival in patients with heart failure and wide QRS, however, long term clinical outcome is unknown.

Aims: To identify predictors of mortality and evaluate the effects of CRT after long term follow-up.

Methods: Consecutive patients treated with CRT between 1997 and 2002 were included. We collected clinical information from patient files. Patients who were still alive underwent echocardiography and clinical evaluation.

Results: We included 179 patients (median age 65.5 years, 144 male). Median follow-up for survival was 4.0 years. Mortality at one and five years was 15% and 53%, respectively. Predictors of mortality were, ischaemic heart disease (IHD), higher NYHA class and lower LVEF (<22.5%) at baseline, and no improvement in NYHA class at early follow-up. NYHA class remained stable from early to long term follow-up after a median of 5.1 years. In patients with non-IHD median LVEF increased significantly from early to long term follow-up (39% vs. 50% p=0.007).

Conclusion: Predictors of mortality in patients with CRT are IHD, lower LVEF and higher NYHA class at baseline, and no symptomatic response to CRT. After 5 years follow-up, clinical effects are sustained, and in patients with non-IHD further improvements in LVEF are observed.

Key Words: Heart failure • Cardiac resynchronization therapy • Mortality • Predictors

Received January 30, 2008; Revised May 22, 2008; Accepted June 23, 2008


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