Cardiac-Resynchronization Therapy in Heart Failure with a Narrow QRS Complex
Open accessAbstract
BACKGROUND: Cardiac-resynchronization therapy (CRT) reduces morbidity and mortality in chronic systolic heart failure with a wide QRS complex. Mechanical dyssynchrony also occurs in patients with a narrow QRS complex, which suggests the potential usefulness of CRT in such patients. METHODS: We conducted a randomized trial involving 115 centers to evaluate the effect of CRT in patients with New York Heart Association class III or IV heart failure, a left ventricular ejection fraction of 35% or less, a QRS duration of less than 130 msec, and echocardiographic evidence of left ventricular dyssynchrony. All patients underwent device implantation and were randomly assigned to have CRT capability turned on or off. The primary efficacy outcome was the composite of death from any cause or first hospitalization for worsening heart failure. RESULTS: On March 13, 2013, the study was stopped for futility on the recommendation of the data and safety monitoring board. At study closure, the 809 patients who had undergone randomization had been followed for a mean of 19.4 months. The primary outcome occurred in 116 of 404 patients in the CRT group, as compared with 102 of 405 in the control group (28.7% vs. 25.2%; hazard ratio, 1.20; 95% confidence interval [CI], 0.92 to 1.57; P=0.15). There were 45 deaths in the CRT group and 26 in the control group (11.1% vs. 6.4%; hazard ratio, 1.81; 95% CI, 1.11 to 2.93; P=0.02). CONCLUSIONS: In patients with systolic heart failure and a QRS duration of less than 130 msec, CRT does not reduce the rate of death or hospitalization for heart failure and may increase mortality. (Funded by Biotronik and GE Healthcare; EchoCRT ClinicalTrials.gov number, NCT00683696.).
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The coexistence of type 2 diabetes mellitus and heart failure, either with reduced or preserved ejection fraction, is frequent, affecting 30-40% of patients.
“The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients)”
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 [33]
In clinical trials of chronic HF patients, the prevalence of T2DM was around 30%, irrespective of HF phenotype.
“In clinical trials of chronic HF patients, the prevalence of T2DM was around 30%, irrespective of HF phenotype (i.e.HFrEF and HFpEF) (Table 3).31 -48”
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 [33]
The highest prevalence of T2DM was seen in trials of acute HF, around 40%.
“The highest prevalence of T2DM was seen in trials of acute HF (around 40%).”
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 [33]
Clinical trial results are somewhat conflicting regarding the risk of all-cause and cardiovascular mortality attributed to T2DM in HF patients, but most clinical trials reported an increased risk of death in patients with concurrent T2DM and HF.
“Clinical trial results are somewhat conflicting regarding the risk of all-cause and CV mortality attributed to T2DM in HF patients, but most clinical trials reported an increased risk of death in patients with concurrent T2DM and HF (Table 5).1,31 -35,37,40,42,44,45,69,88-92”
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 [33]
Three HFrEF trials reported increased cardiovascular death, with hazard ratios between 1.5 and 1.8.
“Also three HFrEF trials reported increased CV death, with HRs between 1.5 and 1.8.1,31,33”
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 [33]
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Role of myocardial constructive work in the identification of responders to CRT
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Self-citationGuía ESC 2021 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica
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Self-citationCardiac Resynchronization Therapy
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QRS Duration or QRS Morphology
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Strategies to improve cardiac resynchronization therapy
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Advances and Future Directions in Cardiac Pacemakers
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Bibliometric analysis on the Progress of chronic heart failure
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Cardiac contractility modulation: a novel approach for the treatment of heart failure
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Self-citationPathobiology of cardiac dyssynchrony and resynchronization therapy
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Indications for Cardiac Resynchronization Therapy
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Self-citation2026 ESC Guidelines for the management of heart failure
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How robust are clinical trials in heart failure?
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Self-citationEpidemiology of heart failure in diabetes: a disease in disguise
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Redefining the Classifications of Response to Cardiac Resynchronization Therapy
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Superresponse to Cardiac Resynchronization Therapy
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The Treatment of Heart Failure with Reduced Ejection Fraction
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Does Cardiac Resynchronization Therapy Benefit Patients With Right Bundle Branch Block
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Self-citationHis Bundle Pacing: A New Frontier in the Treatment of Heart Failure
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JCS/JHRS 2024 Guideline Focused Update on Management of Cardiac Arrhythmias
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Self-citationThe Palliative Care in Heart Failure Trial: Rationale and design
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Cardiac Implantable Electronic Device Therapy in Heart Failure
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Self-citationDistinctive Left Ventricular Activations Associated With ECG Pattern in Heart Failure Patients
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Diretriz Brasileira de Dispositivos Cardíacos Eletrônicos Implantáveis – 2023
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Ventricular dyssynchrony assessment using ultra-high frequency ECG technique
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JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure
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Self-citation
- Authors
- Ruschitzka, F., Abraham, W. T., Singh, J. P., Bax, J. J., Borer, J. S., Brugada, J., Dickstein, K., Ford, I., Gorcsan, J., Gras, D., Krum, H., Sogaard, P., & Holzmeister, J.
- Affiliations
- University Hospital Zurich (CH)
- The Ohio State University Wexner Medical Center (US)
- Harvard University (US)
- Leiden University Medical Center (NL)
- State University of New York (US)
- Stavanger University Hospital (NO)
- University of Glasgow (GB)
- Nouvelles Cliniques Nantaises (FR)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2013-10-10
- Volume
- 369
- Issue
- 15
- Pages
- 1395-1405
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2152517370
- Cited by
- 825
- References
- 32
- Citations by year
- 2026: 23 · 2025: 33 · 2024: 53 · 2023: 41 · 2022: 63 · 2021: 58 · 2020: 53 · 2019: 73 · 2018: 61 · 2017: 80 · 2016: 82 · 2015: 116 · 2014: 71 · 2013: 15 · 2012: 2
- FWCI
- 64.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Keywords
- cardiac resynchronization therapy, heart failure with reduced ejection fraction, narrow QRS complex, left ventricular dyssynchrony, mortality, heart failure hospitalization, CRT device implantation, left ventricular ejection fraction
- MeSH terms
- Aged, Echocardiography, Electrocardiography, Female, Hospitalization, Humans, Male, Middle Aged, Stroke Volume, Treatment Failure, Kaplan-Meier Estimate, Heart Failure, Systolic, Cardiac Resynchronization Therapy
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