Prof. Christophe Leclercq,
Cardiac resynchronization therapy (CRT) is recommended in patients with left ventricular systolic dysfunction, wide QRS and moderate to severe heart failure (NYHA class III and IV) despite optimal drug treatment. In these patients, CRT improves symptoms, quality of life and significantly decreases morbi-mortality. The effects of CRT in patients with mild heart failure are currently evaluated.
What can we expect with CRT in patients with mild heart failure? The results of the MIRACLE ICD II and the CONTAK-CD trials gave some indications: in these two trials no significant improvement in quality of life, symptoms or exercise tolerance. However, as well as observed in “conventional” CRT was associated with a significant left ventricular reverse remodeling, i.e. a significant reduction in left ventricular end-systolic and end-diastolic volumes and an increase in left ventricular ejection fraction. These effects of CRT on LV remodeling are currently evaluated in three on-going trials: the REVERSE trial; the MADIT CRT trial and the RAFT trial. The first results, those of the REVERSE trial, will be presented in 2008. However, the current guidelines, even the most recent guidelines don’t recommend so far CRT in NYHA class II patients.
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The patient with mild heart failure - how to prevent disease progression?
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