Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

HFSA updates recommendations for use of cardiac resynchronization therapy

28.02.2012
New recommendations explained in Journal of Cardiac Failure

Based on a review of the latest evidence, the Guidelines Committee of the Heart Failure Society of America now recommends that the use of cardiac resynchronization therapy (CRT) be expanded to a larger group of patients with mild heart failure symptoms. Recommendations for integrating new evidence into clinical practice appear in the February issue of the Journal of Cardiac Failure.

CRT devices synchronize the function of the left ventricle so that it contracts more efficiently and in a coordinated way. It does this by stimulating the part of the ventricle that is delayed in starting its contraction. This increases the efficiency of the heart and improves survival, morbidity, symptoms, and quality of life. Significant evidence supports the use of these devices, either alone or with an implantable cardioverter defibrillator (ICD), in patients with moderate or severe heart failure (graded class III or class IV according to the New York Heart Association classification system). Recent research has investigated the effect of the treatment in patients with less severe symptoms.

The committee reviewed three large randomized clinical trials of CRT in patients with mild heart failure symptoms, as well as a number of meta-analyses that evaluated the use of CRT regardless of symptom severity. "The totality of the evidence supports the use of CRT in heart failure patients with reduced left ventricular ejection function (LVEF) across the spectrum of mild to severe symptoms," reports senior author Randall C. Starling, MD, MPH, of the Department of Cardiovascular Medicine at the Cleveland Clinic. "The evidence is most compelling among patients with an electrocardiogram QRS duration ¡Ý 150 ms (normal being
Specifically, the Guidelines Committee determined that CRT is recommended for patients in sinus rhythm with a widened QRS interval ¡Ý 150 that is not due to RBBB who have reduced ejection fraction and persistent mild to moderate heart failure, despite optimal medical therapy. CRT may be considered for ambulatory class IV patients with QRS interval ¡Ý 150 ms and severe LV systolic dysfunction. CRT may also be considered for patients with a QRS interval of ¡Ý 120 to

The evidence supporting the QRS thresholds in these recommendations is based primarily on subgroup analyses and systematic reviews rather than on the boundaries of eligibility criteria used in the trial. "Subgroup analyses are generally limited by the potential for chance findings," Dr. Starling notes. "However, the observations that the majority of the benefit exists in the QRS duration ¡Ý 150 ms subgroup has been a consistent finding across multiple clinical trials, and it has been confirmed in meta-analysis. Therefore, the Guideline Committee agreed that the totality of evidence supported the QRS duration thresholds."

"CRT is still a relatively new technology that seemed to come out of nowhere a few years ago," comments HFSA President, Barry Massie, MD. "However, growing evidence leaves little doubt about the value of this technology. Multiple trials have demonstrated that heart failure patients, whose hearts contract in a discordant manner, have more symptoms and poorer survival. The idea that stimulating the heart electrically to improve its efficiency could have a profound effect was greeted with some skepticism but no longer. Multiple trials have demonstrated that this intervention makes patients feel better, prevents hospitalizations, and prolongs survival in heart failure patients. I congratulate the Guideline Committee for taking on this project, reviewing a wide range of data, and making a compelling argument for increased use of this new technology that has a great deal of promise."

Several evidence gaps must be addressed, including the ideal threshold for QRS duration, QRS morphology, lead placement, degree of myocardial scarring, and the best approach to evaluating dyssynchrony. "It is anticipated that the recommendations will evolve to focus on optimizing patient selection and identifying factors that reliably predict a favorable response to CRT, ideally based on criteria that are clinically important to our patients. We envision that this will form the substrate for guidelines to be updated by the Committee," Dr. Starling concludes.

The article is "Indications for Cardiac Resynchronization Therapy: 2011 Update From the Heart Failure Society of American Guideline Committee," by W.G. Stevenson, A.F. Hernandez, P.E. Carson, et al. (DOI: 10.1016/j.cardfail.2011.12.004). It appears in the Journal of Cardiac Failure, Volume 18, Issue 2 (February 2012).

Jane Grochowski | EurekAlert!
Further information:
http://www.elsevier.com

More articles from Health and Medicine:

nachricht Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University

nachricht The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

Im Focus: Fraunhofer ISE Develops Highly Compact, High Frequency DC/DC Converter for Aviation

The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.

Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

UTSA study describes new minimally invasive device to treat cancer and other illnesses

02.12.2016 | Medical Engineering

Plasma-zapping process could yield trans fat-free soybean oil product

02.12.2016 | Agricultural and Forestry Science

What do Netflix, Google and planetary systems have in common?

02.12.2016 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>