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Is the outcome of cardiac resynchronization therapy related to the underlying etiology?

Maurizio Gasparini1, Massimo Mantica, Paola Galimberti

  • 1Department of Cardiology, Humanitas Clinical Institute, Rozzano, Milan, Italy. maurizio.gasparini@humanitas.it

Pacing and Clinical Electrophysiology : PACE
|April 12, 2003
PubMed

Insights

Cardiac resynchronization therapy (CRT) improves heart failure outcomes, but non-ischemic dilated cardiomyopathy patients show greater benefits than those with coronary artery disease. Underlying cardiac pathology impacts CRT effectiveness.

Area of Science:

  • Cardiology
  • Heart Failure Management
  • Cardiac Electrophysiology

Background:

  • Dilated cardiomyopathy (DCM) is a common cause of heart failure.
  • Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction and wide QRS duration.
  • The impact of underlying cardiac pathology, specifically coronary artery disease (CAD) versus non-ischemic etiologies, on CRT outcomes is not fully elucidated.

Purpose of the Study:

  • To investigate the influence of underlying cardiac pathology on the effectiveness of CRT.
  • To compare CRT outcomes in patients with DCM due to CAD versus non-ischemic causes.
  • To determine if myocardial scar tissue limits CRT benefits.

Main Methods:

  • A single-center, longitudinal, comparative study included 158 patients with DCM and CRT indications.
  • Patients were divided into a coronary artery disease (CAD) group and a non-CAD (non-ischemic DCM) group.
  • Outcomes including left ventricular ejection fraction (LVEF), 6-minute walk test (6MWT), and NYHA functional class were assessed at baseline and follow-up.

Main Results:

  • Both CAD and non-CAD groups showed significant improvements in LVEF, 6MWT distance, and NYHA class after CRT.
  • Patients in the non-CAD group experienced a significantly greater increase in LVEF (P = 0.007) and a greater decrease in NYHA class (P < 0.05) compared to the CAD group.
  • Despite improvements in the CAD group, non-CAD patients demonstrated superior response to CRT.

Conclusions:

  • Underlying cardiac pathology significantly influences CRT outcomes in patients with dilated cardiomyopathy.
  • Non-ischemic dilated cardiomyopathy patients achieve better improvements in LVEF and functional class with CRT compared to those with CAD.
  • Myocardial scar in CAD may represent a limitation to achieving optimal cardiac resynchronization and functional improvement with CRT.

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