Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events

Moss, Arthur J.; Hall, W. Jackson; Cannom, David S.; Klein, Helmut; Brown, Mary W.; Daubert, James P.; Estes, N.A. Mark; Foster, Elyse; Greenberg, Henry; Higgins, Steven L.; Pfeffer, Marc A.; Solomon, Scott D.; Wilber, David; Zareba, Wojciech

doi:10.1056/nejmoa0906431

Cited by 3,157Cardiac pacing and defibrillation studiesCardiac Arrest and ResuscitationCardiac Health and Mental Health

Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events

Moss, Arthur J., Hall, W. Jackson, Cannom, David S., Klein, Helmut, Brown, Mary W., Daubert, James P., Estes, N.A. Mark, Foster, Elyse +6 more·2009·New England Journal of Medicine

DOI 10.1056/nejmoa0906431

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Abstract

BACKGROUND: This trial was designed to determine whether cardiac-resynchronization therapy (CRT) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms, a reduced ejection fraction, and a wide QRS complex. METHODS: During a 4.5-year period, we enrolled and followed 1820 patients with ischemic or nonischemic cardiomyopathy, an ejection fraction of 30% or less, a QRS duration of 130 msec or more, and New York Heart Association class I or II symptoms. Patients were randomly assigned in a 3:2 ratio to receive CRT plus an implantable cardioverter-defibrillator (ICD) (1089 patients) or an ICD alone (731 patients). The primary end point was death from any cause or a nonfatal heart-failure event (whichever came first). Heart-failure events were diagnosed by physicians who were aware of the treatment assignments, but they were adjudicated by a committee that was unaware of assignments. RESULTS: During an average follow-up of 2.4 years, the primary end point occurred in 187 of 1089 patients in the CRT-ICD group (17.2%) and 185 of 731 patients in the ICD-only group (25.3%) (hazard ratio in the CRT-ICD group, 0.66; 95% confidence interval [CI], 0.52 to 0.84; P=0.001). The benefit did not differ significantly between patients with ischemic cardiomyopathy and those with nonischemic cardiomyopathy. The superiority of CRT was driven by a 41% reduction in the risk of heart-failure events, a finding that was evident primarily in a prespecified subgroup of patients with a QRS duration of 150 msec or more. CRT was associated with a significant reduction in left ventricular volumes and improvement in the ejection fraction. There was no significant difference between the two groups in the overall risk of death, with a 3% annual mortality rate in each treatment group. Serious adverse events were infrequent in the two groups. CONCLUSIONS: CRT combined with ICD decreased the risk of heart-failure events in relatively asymptomatic patients with a low ejection fraction and wide QRS complex. (ClinicalTrials.gov number, NCT00180271.)

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In MADIT-CRT, CRT-D treatment, compared with optimal medical therapy plus ICD, led to a similar reduction in the risk of all-cause death or HF hospitalization in patients with and without T2DM (adjusted HRs 0.56 and 0.67, respectively).
“In MADIT-CRT, CRT-D treatment, compared with optimal medical therapy plus ICD, led to a similar reduction in the risk of all-cause death or HF hospitalization in patients with and without T2DM (adjusted HRs 0.56 and 0.67, respectively).169,173”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [169]

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Authors: Moss, A. J., Hall, W. J., Cannom, D. S., Klein, H., Brown, M. W., Daubert, J. P., Estes, N. A. M., Foster, E., Greenberg, H., Higgins, S. L., Pfeffer, M. A., Solomon, S. D., Wilber, D., & Zareba, W.
Affiliations: University of Rochester Medicine (US)
Good Samaritan Hospital (US)
Duke Medical Center (US)
University of California, San Francisco (US)
St. Luke's-Roosevelt Hospital Center (US)
Scripps Memorial Hospital (US)
Brigham and Women's Hospital (US)
Loyola University Medical Center (US)
ORCID: Moss, Arthur J.
Hall, W. Jackson
Cannom, David S.
Klein, Helmut
Daubert, James P.
Greenberg, Henry
Pfeffer, Marc A.
Solomon, Scott D.
Wilber, David
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2009-10
Volume: 361
Issue: 14
Pages: 1329-1338
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa0906431
OpenAlex: W2146521529
Cited by: 3,157
References: 17
Citations by year: 2026: 106 · 2025: 116 · 2024: 137 · 2023: 188 · 2022: 140 · 2021: 155 · 2020: 163 · 2019: 173 · 2018: 174 · 2017: 199 · 2016: 210 · 2015: 210 · 2014: 227 · 2013: 243 · 2012: 267
FWCI: 151.00
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords: cardiac resynchronization therapy, implantable cardioverter-defibrillator, heart failure prevention, reduced ejection fraction, wide QRS complex, ischemic cardiomyopathy, non-ischemic cardiomyopathy, left ventricular volume, ejection fraction, mortality, asymptomatic patients
MeSH terms: Aged, Cardiac Pacing, Artificial, Electric Countershock, Female, Heart Failure, Humans, Male, Middle Aged, Pacemaker, Artificial, Stroke Volume, Defibrillators, Implantable, Disease-Free Survival, Kaplan-Meier Estimate

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Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events

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