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How many patients with dilated cardiomyopathy may potentially benefit from cardiac resynchronization therapy?
Wolfram Grimm1, Julia Sharkova, Reinhard Funck
1Department of Cardiology, Hospital of the Philipps-University of Marburg, Baldingerstrasse, 35033 Marburg, Germany. Wolfram.Grimm@med.uni-marburg.de
Insights
Cardiac resynchronization therapy (CRT) candidacy varies for dilated cardiomyopathy (DCM) patients. Strict criteria identified 7% of patients, while less restrictive criteria identified 14% eligible for biventricular or left ventricular pacing.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Dilated cardiomyopathy (DCM) affects millions globally, often leading to heart failure.
- Cardiac resynchronization therapy (CRT) is a treatment option for select heart failure patients.
Purpose of the Study:
- To determine the proportion of DCM patients eligible for CRT based on varying selection criteria.
- To analyze the impact of restrictive versus less restrictive criteria on CRT candidacy.
Main Methods:
- Analysis of the Marburg Cardiomyopathy database (n=566).
- Application of strict criteria: NYHA class ≥3, LVEF <30%, sinus rhythm, LBBB, QRS duration ≥150 ms.
- Application of less restrictive criteria: NYHA class ≥3, LVEF <35%, QRS duration ≥120 ms (any BBB).
Main Results:
- Strict criteria identified 7% (38/566) of patients as CRT candidates.
- Less restrictive criteria identified 14% (78/566) of patients as CRT candidates.
- Significant differences in candidacy based on criteria stringency were observed.
Conclusions:
- CRT candidacy in DCM patients is highly dependent on the selection criteria used.
- A substantial proportion of DCM patients may be eligible for CRT, warranting careful consideration of criteria.
- Further research may refine optimal patient selection for CRT in DCM.
Abstract:
The clinical and electrocardiographic Marburg Cardiomyopathy database was analyzed to identify potential candidates for cardiac resynchronization therapy (CRT) with biventricular or left ventricular pacing among 566 patients with dilated cardiomyopathy (DCM). All of the following restrictive selection criteria were fulfilled by 38 patients (7%): NYHA functional class > or = 3 (n = 193, 34%), left ventricular ejection fraction (LVEF) < 30% (n = 238, 42%), sinus rhythm (n = 437, 77%), left bundle branch block (LBBB, n = 142, 25%), and QRS duration > or = 150 ms (n = 136, 24%). In 78 of the 566 patients (14%) all of the following less restrictive selection criteria were fulfilled: NYHA functional class > or = 3 (n = 193, 34%), LVEF < 35% in presence of any underlying rhythm (n = 326, 58%), QRS duration > or = 120 ms with right or left bundle branch block (n = 223, 39%). Thus, between 7% and 14% of patients with DCM were candidates for CRT depending on the application of strict versus less restrictive selection criteria.