Author + information
- Gregory Sinner,
- You W. Lin,
- Samy-Claude Elayi and
- Maya Guglin
Background: Cardiac resynchronization therapy (CRT) is recommended for patients with reduced ejection fraction (EF) and left bundle branch block (LBBB) on guideline-directed medical therapy (GDMT) for at least 3 months. For a subset of patients with wide LBBB and non-ischemic cardiomyopathy (NICM) in whom the LBBB directly contributes to the NICM, the use of CRT rather than the GDMT may be the key to improving the cardiomyopathy. The purpose of this study was to better understand the utility of GDMT prior to CRT.
Methods: This retrospective review included patients with NICM and LBBB with QRS >130 ms who underwent CRT (N=56). Patients were grouped according to presence (Group 1) or absence (Group 2) of optimal GDMT prior to CRT. Changes in EF were compared pre- and post-CRT using student t-tests. Patients without documented EF were excluded from analysis.
Left ventricular volume and EF improvements after CRT were similar between patients in Groups 1 and 2. Group 1 patients experienced an 18.8% decrease in EF while on GDMT before CRT compared to a 50.5% increase in EF after CRT (p<0.05).
Conclusions: Patients with NICM and LBBB experience similar EF increase after CRT independent of optimal GDMT prior to implant. Furthermore, EF may worsen while optimizing GDMT and waiting for device implant. This study suggests some patients with LBBB and resultant NICM may benefit from earlier resynchronization rather than waiting to optimize GDMT.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure and Cardiomyopathies: Heart Failure Gadgets Galore
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1199-253
- 2017 American College of Cardiology Foundation