Cardiac resynchronisation therapy in patients with heart failure and a normal QRS duration: the RESPOND study

Paul W X Foley, Kiran Patel, Nick Irwin, John E Sanderson, Michael P Frenneaux, Russell E A Smith, Berthold Stegemann, Francisco Leyva

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Abstract

OBJECTIVES: To evaluate the clinical response to cardiac resynchronisation therapy (CRT) in patients with heart failure and a normal QRS duration (<120 ms).

SETTING: Single centre.

PATIENTS: 60 patients with heart failure and a normal QRS duration receiving optimal pharmacological treatment (OPT).

INTERVENTIONS: Patients were randomly assigned to CRT (n=29) or to a control group (OPT, n=31). Cardiovascular magnetic resonance was used in order to avoid scar at the site of left ventricular (LV) lead deployment.

MAIN OUTCOME MEASURES: The primary end point was a change in 6 min walking distance (6-MWD). Other measures included a change in quality of life scores (Minnesota Living with Heart Failure questionnaire) and New York Heart Association class.

RESULTS: In 93% of implantations, the LV lead was deployed over non-scarred myocardium. At 6 months, the 6-MWD increased with CRT compared with OPT (p<0.0001), with more patients reaching a =25% increase (51.7% vs 12.9%, p=0.0019). Compared with OPT, CRT led to an improvement in quality-of-life scores (p=0.0265) and a reduction in NYHA class (p<0.0001). The composite clinical score (survival for 6 months free of heart failure hospitalisations plus improvement by one or more NYHA class or by =25% in 6-MWD) was better in CRT than in OPT (83% vs 23%, respectively; p<0.0001). Although no differences in total or cardiovascular mortality emerged between OPT and CRT, patients receiving OPT had a higher risk of death from pump failure than patients assigned to CRT (HR=8.41, p=0.0447) after a median follow-up of 677.5 days.

CONCLUSIONS: CRT leads to an improvement in symptoms, exercise capacity and quality of life in patients with heart failure and a normal QRS duration. (ClinicalTrials.gov number, NCT00480051.).
Original languageEnglish
Pages (from-to)1041-1047
Number of pages7
JournalHeart
Volume97
Issue number13
Early online date21 Feb 2011
DOIs
Publication statusPublished - Jul 2011

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Keywords

  • adult
  • aged
  • aged, 80 and over
  • cardiac resynchronization therapy
  • electrocardiography
  • epidemiologic methods
  • exercise test
  • female
  • heart failure
  • humans
  • male
  • middle aged
  • pacemaker, artificial
  • quality of life
  • treatment outcome
  • walking

Cite this

Foley, P. W. X., Patel, K., Irwin, N., Sanderson, J. E., Frenneaux, M. P., Smith, R. E. A., ... Leyva, F. (2011). Cardiac resynchronisation therapy in patients with heart failure and a normal QRS duration: the RESPOND study. Heart, 97(13), 1041-1047. https://doi.org/10.1136/hrt.2010.208355