CRT with defibrillation trumps pacing in NICM patients with +MWF
Cardiac resynchronization therapy with defibrillation (CRT-D) is superior to CRT(-P) with pacing in nonischaemic cardiomyopathy (NICM) patients with left ventricular midwall fibrosis (+MWF) but not in those without (-MWF), according to a recent study.
Researchers calculated clinical events in patients with NICM who were +MWF (n=68) or ‒MWF (n=184) and who underwent cardiac magnetic resonance prior to CRT device implantation to determine whether CRT-D was better than CRT-P.
Among the included patients, +MWF appeared to independently predict total mortality (adjusted hazard ratio [aHR], 2.31; 95 percent CI, 1.45 to 3.68), total mortality or heart failure hospitalization (aHR, 2.02; 1.32 to 3.09), total mortality or hospitalization for major adverse cardiac events (aHR, 2.02; 1.32 to 3.07), death from pump failure (aHR, 1.95; 1.11 to 3.41), and sudden cardiac death (aHR, 3.75; 1.26 to 11.2) over a maximum follow-up period of 14 years (median 3.8 years; IQR, 2.0 to 6.1 years for +MWF and 4.6 years; IQR, 2.4 to 8.3 years for ‒MWF).
Separate analyses of +MWF and ‒MWF revealed that total mortality (aHR, 0.23; 0.07 to 0.75), total mortality or heart failure hospitalization (aHR, 0.32; 0.12 to 0.82), and total mortality or hospitalization for major adverse cardiac events (aHR, 0.30; 0.12 to 0.78) were lower after CRT-D than after CRT-P in NICM patients who were +MWF, but not in those who were −MWF.
These findings have significant implications for the choice of device therapy in NICM patients, according to researchers.
“Recent studies have cast doubt on the benefit of CRT-D versus CRT-P for patients with NICM. Left ventricular myocardial scar portends poor clinical outcomes,” they noted.