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European Heart Journal Advance Access originally published online on June 10, 2009
European Heart Journal 2009 30(18):2275-2283; doi:10.1093/eurheartj/ehp226
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Effectiveness of cardiac resynchronization therapy in heart failure patients with valvular heart disease: comparison with patients affected by ischaemic heart disease or dilated cardiomyopathy. The InSync/InSync ICD Italian Registry

Giuseppe Boriani1,*, Maurizio Gasparini2, Maurizio Landolina3, Maurizio Lunati4, Mauro Biffi1, Massimo Santini5, Luigi Padeletti6, Giulio Molon7, Gianluca Botto8, Tiziana De Santo9, Sergio Valsecchi9 on behalf of the InSync/InSync ICD Italian Registry Investigators

1 Institute of Cardiology, University of Bologna, Azienda Ospedaliera S.Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
2 IRCCS Istituto Clinico Humanitas, Rozzano (Milan), Italy
3 Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy
4 Niguarda Hospital, Milan, Italy
5 S.Filippo Neri Hospital, Rome, Italy
6 University of Florence, Florence, Italy
7 Sacro Cuore Hospital, don Calabria, Negrar, Verona, Italy
8 S. Anna Hospital, Como, Italy
9 Medtronic Italia, Rome, Italy

Received 27 January 2009; revised 5 April 2009; accepted 6 May 2009; online publish-ahead-of-print 10 June 2009.

* Corresponding author. Tel: +39 051 349858, Fax: +39 051 344859, Email: giuseppe.boriani{at}unibo.it

Aims: To analyse the effectiveness of cardiac resynchronization therapy (CRT) in patients with valvular heart disease (a subset not specifically investigated in randomized controlled trials) in comparison with ischaemic heart disease or dilated cardiomyopathy patients.

Methods and results: Patients enrolled in a national registry were evaluated during a median follow-up of 16 months after CRT implant. Patients with valvular heart disease treated with CRT (n = 108) in comparison with ischaemic heart disease (n = 737) and dilated cardiomyopathy (n = 635) patients presented: (i) a higher prevalence of chronic atrial fibrillation, with atrioventricular node ablation performed in around half of the cases; (ii) a similar clinical and echocardiographic profile at baseline; (iii) a similar improvement of LVEF and a similar reduction in ventricular volumes at 6–12 months; (iv) a favourable clinical response at 12 months with an improvement of the clinical composite score similar to that occurring in patients with dilated cardiomyopathy and more pronounced than that observed in patients with ischaemic heart disease; (v) a long-term outcome, in term of freedom from death or heart transplantation, similar to patients affected by ischaemic heart disease and basically more severe than that of patients affected by dilated cardiomyopathy.

Conclusion: In ‘real world’ clinical practice, CRT appears to be effective also in patients with valvular heart disease. However, in this group of patients the outcome after CRT does not precisely overlap any of the two other groups of patients, for which much more data are currently available.

Key Words: Cardiac resynchronization therapy • Heart failure • Valvular heart disease • Remodelling


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