{"id":38371,"date":"2013-09-03T02:00:50","date_gmt":"2013-09-03T06:00:50","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=38371"},"modified":"2013-09-03T20:43:16","modified_gmt":"2013-09-04T00:43:16","slug":"cardiac-resynchronization-therapy","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/09\/03\/cardiac-resynchronization-therapy\/","title":{"rendered":"Study Fails to Support Broader Patient Population for Cardiac-Resynchronization Therapy"},"content":{"rendered":"<p><em>For more of our ESC.13 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our\u00a0<a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/voices\/esc-13-headquarters\/\">Coverage Headquarters<\/a>.<\/em><\/p>\n<p>Cardiac-resynchronization therapy (CRT) has been shown to be beneficial in heart failure (HF) patients with a wide QRS interval. These benefits have not been reproduced so far in patients with narrow QRS intervals, though many such patients have ventricular dyssynchrony. Now <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1306687?query=featured_home\">a new study<\/a>, presented at the European Society of Cardiology in Amsterdam and published simultaneously in the <em>New England Journal of Medicine<\/em>, once again has failed to find benefits for CRT in a broader patient population.<\/p>\n<p>The EchoCRT Study Group randomized\u00a0HF patients with a QRS duration &lt; 130 msec and left ventricular dyssnchrony upon echocardiography. All patients received a CRT-D device; half the patients were randomized to have the CRT feature activated.<\/p>\n<p>The study was stopped prematurely after 809 patients had been randomized and followed for nearly 20 months.<\/p>\n<ul>\n<li>The primary endpoint (composite of death from any cause or first hospitalization for worsening HF) occurred in 28.7% of the CRT group versus 25.2% of the controls (HR 1.20, CI 0.92-1.57, p=0.15)<\/li>\n<li>There was a significant increase in mortality in the CRT group :11.1% versus 6.4%, CI 1.11-2.93, p=0.02)<\/li>\n<\/ul>\n<p>There were also more\u00a0inappropriate shocks in the CRT group and\u00a0more adverse events\u00a0\u2014 largely driven by lead-related complications \u2014 in the CRT group.<\/p>\n<p>&#8220;Our results reinforce the notion that, at least until new methods of assessment are developed, QRS width with or without mechanical dyssynchrony) remains the primary determinant of response to CRT,&#8221; the authors write.<\/p>\n<p><strong>Definitive Results<\/strong><\/p>\n<p>In <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe1310406?query=featured_home\">an accompanying editorial<\/a>, Clyde Yancy and John McMurray say the results of the trial &#8220;were definitive: CRT is not beneficial in patients with\u00a0HF and a narrow QRS complex and may be harmful.&#8221;\u00a0They also sought to emphasize that &#8220;&#8230;CRT itself is not without risk, including periprocedural complications, lead-related issues, and inadvertent right ventricular pacing that aggravates left ventricular dysfunction.&#8221;<\/p>\n<p>CRT is unwarranted in patients with a QRS duration &lt; 120 msec, while for patients between 120 and 130 msec, current guidelines should be followed, though echo should not be used to identify patients who may benefit from CRT.<\/p>\n<p>&#8220;Today, in addition to measurement of left ventricular ejection fraction, the simple 12-lead surface ECG remains the only evidence-based means of identifying patients who may obtain the substantial benefits of CRT.&#8221;<\/p>\n<p>See also <a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/voices\/echo-crt-trial-going-narrow-doesnt-broaden-crt-population\/\">Edward J. Schloss&#8217;s perspective on EchoCRT<\/a>.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A new study from the Echo-CRT study group shows that CRT is not beneficial in patients with HF and a narrow QRS complex and may even be harmful.<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,14],"tags":[542,1216,498,543],"class_list":["post-38371","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","category-heart-failure","tag-crt","tag-ecg","tag-echocardiography","tag-icd"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/38371","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=38371"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/38371\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=38371"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=38371"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=38371"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}