Does cardiac resynchronization therapy reduce the long-term mortality risk in patients with heart failure?
David A Kass
Correspondence Division of Cardiology, Johns Hopkins Medical Institutions, Ross 835, 720 Rutland Avenue, Baltimore, MD 21205, USA
Email dkass@jhmi.edu
This article has no abstract so we have provided the first paragraph of the full text.
Therapies for advanced HF that improve systolic function without literally replacing the pump by transplantation have had a troublesome past, with early benefits often leading to chronic detriments that increase mortality. CRT seems to be different, however, as it enhances systolic function without increasing cardiac energetic costs, and results in sustained symptomatic improvement. In the COMPANION trial,1 reduced mortality was demonstrated in patients receiving CRT with an internal defibrillator, while in the CARE-HF study,2 mortality reduction was observed with CRT alone. The CARE-HF investigators have now extended their analysis, with a mean follow-up period of just over 3 years. Importantly, CRT was associated with a sustained reduction in all-cause mortality, death from worsening HF, and sudden cardiac death. The last is important, as defibrillators were not specifically combined with CRT in this trial. CRT has, therefore, become one of only two treatments—
-blockers combined with angiotensin-converting-enzyme inhibitors being the other—that reduce sudden death caused by fatal arrhythmia or electromechanical failure in HF.
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