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 Research offers clues for improved influenza vaccine design
09.04.2018 | NIH/National Institute of Allergy and Infectious Diseases

nachricht Injecting gene cocktail into mouse pancreas leads to humanlike tumors
06.04.2018 | University of Texas Health Science Center at San Antonio

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: Gamma-ray flashes from plasma filaments

Novel highly efficient and brilliant gamma-ray source: Based on model calculations, physicists of the Max PIanck Institute for Nuclear Physics in Heidelberg propose a novel method for an efficient high-brilliance gamma-ray source. A giant collimated gamma-ray pulse is generated from the interaction of a dense ultra-relativistic electron beam with a thin solid conductor. Energetic gamma-rays are copiously produced as the electron beam splits into filaments while propagating across the conductor. The resulting gamma-ray energy and flux enable novel experiments in nuclear and fundamental physics.

The typical wavelength of light interacting with an object of the microcosm scales with the size of this object. For atoms, this ranges from visible light to...

Im Focus: Basel researchers succeed in cultivating cartilage from stem cells

Stable joint cartilage can be produced from adult stem cells originating from bone marrow. This is made possible by inducing specific molecular processes occurring during embryonic cartilage formation, as researchers from the University and University Hospital of Basel report in the scientific journal PNAS.

Certain mesenchymal stem/stromal cells from the bone marrow of adults are considered extremely promising for skeletal tissue regeneration. These adult stem...

Im Focus: Like a wedge in a hinge

Researchers lay groundwork to tailor drugs for new targets in cancer therapy

In the fight against cancer, scientists are developing new drugs to hit tumor cells at so far unused weak points. Such a “sore spot” is the protein complex...

Im Focus: The Future of Ultrafast Solid-State Physics

In an article that appears in the journal “Review of Modern Physics”, researchers at the Laboratory for Attosecond Physics (LAP) assess the current state of the field of ultrafast physics and consider its implications for future technologies.

Physicists can now control light in both time and space with hitherto unimagined precision. This is particularly true for the ability to generate ultrashort...

Im Focus: Stronger evidence for a weaker Atlantic overturning

The Atlantic overturning – one of Earth’s most important heat transport systems, pumping warm water northwards and cold water southwards – is weaker today than any time before in more than 1000 years. Sea surface temperature data analysis provides new evidence that this major ocean circulation has slowed down by roughly 15 percent since the middle of the 20th century, according to a study published in the highly renowned journal Nature by an international team of scientists. Human-made climate change is a prime suspect for these worrying observations.

“We detected a specific pattern of ocean cooling south of Greenland and unusual warming off the US coast – which is highly characteristic for a slowdown of the...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Invitation to the upcoming "Current Topics in Bioinformatics: Big Data in Genomics and Medicine"

13.04.2018 | Event News

Unique scope of UV LED technologies and applications presented in Berlin: ICULTA-2018

12.04.2018 | Event News

IWOLIA: A conference bringing together German Industrie 4.0 and French Industrie du Futur

09.04.2018 | Event News

 
Latest News

Improved stability of plastic light-emitting diodes

19.04.2018 | Power and Electrical Engineering

Enduring cold temperatures alters fat cell epigenetics

19.04.2018 | Life Sciences

New capabilities at NSLS-II set to advance materials science

18.04.2018 | Materials Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>