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Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events
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).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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Metadata
- 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
- 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
- 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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