Relationship between pre-implant ejection fraction and outcome after cardiac resynchronization therapy in symptomatic patients

Andreas Schuchert, Carmine Muto, Themistoklis Maounis, Rita Omega Ella, Alexander Polauck, Luigi Padeletti, Fiorenzo Acquati, Francesco Alessandrini, Maria Grazia Bongiorni, Johannes Brachmann, Valeria Calvi, Ngai Yin Chan, Per Dahl Christensen, Pierre Fiorello, Daniel Flammang, Francesco Foti, Robert Frank, Antonio Fusco, Grahame Goode, Daniel GrasMichael Gruska, Gael Jauvert, Salem Kachboura, Gert Kaltofen, Wolfgang Kiowski, Francesco Lisi, Themistoclis Maounis, Eraldo Occhetta, Luigi Padeletti, Olivier Piot, Jean Ernst Poulard, Jean Luc Rey, Nadir Saoudi, Olivier Thomas, Bernardo Tuccillo, Thomas Vesterlund, Paul Vock, Arnd Weide, Paolo Zecchi

Research output: Contribution to journalArticlepeer-review


Background: Left-ventricular ejection fraction (LVEF) is regarded as a strong predictor for morbidity and mortality in heart failure patients. The aim of the analysis was to assess the relationship between pre-implant LVEF and outcome of patients with advanced heart failure who received cardiac resynchronization therapy (CRT). Methods: We analysed the two-year follow-up of 366 patients who had been enrolled in the MASCOT study which included NYHA class III/IV patients with a class I CRT indication. Pre-implant LVEF was stratified by tertile. Results: The boundaries for pre-implant LVEF were <22% (n = 128; 18.2 ± 3.1%; Tlow), 22% to 28% (n = 121; 25.4 ± 1.4%; Tmiddle) and > 28% (n = 117; 32.6 ± 3.9%; Thigh) for each tertile. Two-year post-implant LVEF was 32.0 ± 11.5% (Tlow), 33.7 ± 10.8% (Tmiddle) and 36.4 ± 9.9% (Thigh). Tlow had a greater increase between pre- and post-implant LVEF compared to Tmiddle (P = 0.03) and Thigh (P = 0.0001). NYHA class improved similarly among the three groups as well as the quality of life score. No significant differences were detected between the three groups for all-cause mortality, cardiac death, all-cause hospitalization, and hospitalization due to worsening heart failure. Conclusions: Symptomatic heart failure patients with a wide QRS complex and a severe impaired LV function had a better improvement of their pre-implant LVEF than patients with a more preserved LVEF. This may be one reason that in these patient groups long-term morbidity and mortality were not related to their pre-implant LVEF. Pre-implant LVEF was in symptomatic CRT patients not predictive for their long-term cardiovascular morbidity and mortality.

Original languageEnglish
Pages (from-to)424-432
Number of pages9
JournalActa Cardiologica
Issue number4
Publication statusPublished - 2014


  • Cardiac resynchronization therapy
  • Echocardiography
  • Heart failure
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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