Long-Term Follow-Up of Patients with Refractory Heart Failure and Myocardial Ischemia Treated with Cardiac Resynchronization Therapy

Studies in patients without coronary artery disease have shown the restoration of glucose metabolism by cardiac resynchronization therapy (CRT) without changes in myocardial perfusion. We report on the long-term outcome of CRT in 24 patients with severe heart failure (HF) and advanced coronary artery disease not amenable for revascularization. All patients had documented myocardial ischemia on stress ⁹⁹Tc-sestamibi single-photon emission computed tomography, and all underwent successful implantations of CRT systems. The mean left ventricular ejection fraction was 21%± 4%, 19 patients (79%) had anginal complaints and 20 (83%) had diffuse three-vessel disease. During a follow-up of 13 ± 0.7 months, two patients died suddenly and one died of progressive HF. Among survivors, functional capacity decreased from New York Heart Association class 3.2 ± 1.4 to 2.1 ± 1.0 (P < 0.01), and the Minnesota questionnaire quality-of-life scores decreased from 43 ± 15 to 28 ± 13 (P < 0.01). Despite an increase from 264 ± 104 to 385 ± 121 m in distance walked in 6 minutes (P < 0.01), the number of anginal attacks/week remained unchanged (4.7 ± 0.7 to 4.5 ± 0.6). Patients with advanced HF, stable angina, and documented myocardial ischemia may undergo safe and successful implantations of CRT systems.