Beneficio clínico de la terapia de resincronización cardiaca con desfibrilador para pacientes con fracción de eyección > 35% por resonancia magnética |
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Authors: | Ó scar Fabregat-André s,Pilar Garcí a-Gonzá lez,Alfonso Valle-Muñ oz,Jordi Estornell-Erill,Leandro Pé rez-Boscá ,Victor Palanca-Gil,Rafael Payá -Serrano,Aurelio Quesada-Dorador,Salvador Morell,Francisco Ridocci-Soriano |
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Affiliation: | 1. Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España;2. Servicio de Cardiología, Hospital Marina Salud, Denia, Valencia, España;3. Unidad de Imagen Cardiaca, ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, España;4. Departamento de Medicina, Facultad de Medicina, Universitat de València, Valencia, España |
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Abstract: | Introduction and objectivesCardiac resynchronization therapy with a defibrillator prolongs survival and improves quality of life in advanced heart failure. Traditionally, patients with ejection fraction > 35% estimated by echocardiography have been excluded. We assessed the prognostic impact of this therapy in a group of patients with severely depressed systolic function as assessed by echocardiography but with an ejection fraction > 35% as assessed by cardiac magnetic resonance.MethodsWe analyzed consecutive patients admitted for decompensated heart failure between 2004 and 2011. The patients were in functional class II-IV, with a QRS ≥ 120 ms, ejection fraction ≤ 35% estimated by echocardiography, and a cardiac magnetic resonance study. We included all patients (n = 103) who underwent device implantation for primary prevention. Ventricular arrhythmia, all-cause mortality and readmission for heart failure were considered major cardiac events. The patients were divided into 2 groups according to systolic function assessed by magnetic resonance.ResultsThe 2 groups showed similar improvements in functional class and ejection fraction at 6 months. We found a nonsignificant trend toward a higher risk of all-cause mortality in patients with systolic function ≤ 35% at long-term follow-up. The presence of a pattern of necrosis identified patients with a worse prognosis for ventricular arrhythmias and mortality in both groups.ConclusionsWe conclude that cardiac resynchronization therapy with a defibrillator leads to a similar clinical benefit in patients with an ejection fraction ≤ 35% or > 35% estimated by cardiac magnetic resonance. Analysis of the pattern of late gadolinium enhancement provides additional information on arrhythmic risk and long-term prognosis.Full English text available from:www.revespcardiol.org/en |
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Keywords: | FEVI, fracció n de eyecció n del ventrí culo izquierdo IC, insuficiencia cardiaca RM, resonancia magné tica RTG, realce tardí o de gadolinio TRC, terapia de resincronizació n cardiaca |
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