One-year outcome after CRT implantation in NYHA class IV in comparison to NYHA class III patients

Andreas Schuchert, Carmine Muto, Themistoklis Maounis, Robert Frank, Rita Omega Ella, Alexander Polauck, Luigi Padeletti

Research output: Contribution to journalArticle

Abstract

Background: The aim of the analysis was to compare the outcome of heart failure patients in New York Heart Association (NYHA) class IV to that of NYHA class III patients 1 year after implantation of a CRT device. Methods: The analysis was based on the 405 CRT patients enrolled in the MASCOT trial. At enrollment, 350 patients (86 %) were in NYHA class III and 55 (14 %) were in NYHA class IV. Results: At 1-year follow-up, the improvement of the ejection fraction was not statistically significantly different between NYHA class III (+7.6 ± 11.7 %) and NYHA class IV patients (+9.2 ± 14.2 %; p = 0.78). NYHA class IV patients had a better mean NYHA class reduction with -1.93 ± 0.83 than NYHA class III patients with -0.93 ± 0.70 (p <0.0001). There was a greater mean quality of life improvement in NYHA class IV (-27.2 ± 20.9) compared to NYHA class III (-17.7 ± 23.9; p = 0.02). All-cause mortality as well as cardiac mortality remained higher in NYHA class IV with 25.5 and 16.4 % than in NYHA class III with 7.1 and 3.1 % (p <0.0001). Conclusions: In this study, 14 % of all patients receiving a CRT device had NYHA class IV at implantation. The data support the concept to implant a CRT device in NYHA class IV patients, because at 1 year after implantation, they experienced better symptomatic improvement compared to NYHA class III patients. The higher cardiac as well as non-cardiac mortality resulted in a fivefold higher all-cause mortality compared to NYHA class III patients.

Original languageEnglish
Pages (from-to)505-511
Number of pages7
JournalClinical Research in Cardiology
Volume102
Issue number7
DOIs
Publication statusPublished - Jul 2013

Keywords

  • CRT implantation
  • Mortality
  • NYHA functional class IV
  • Quality of life score
  • Severe end-stage heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Schuchert, A., Muto, C., Maounis, T., Frank, R., Ella, R. O., Polauck, A., & Padeletti, L. (2013). One-year outcome after CRT implantation in NYHA class IV in comparison to NYHA class III patients. Clinical Research in Cardiology, 102(7), 505-511. https://doi.org/10.1007/s00392-013-0558-1