CRT-D better than CRT-P in NIDCM with left ventricular midwall fibrosis

CRT-D better than CRT-P in NIDCM with left ventricular midwall fibrosis

CRT-D better than CRT-P in NIDCM: Francisco Leyva and colleagues compared the outcomes of cardiac resynchronization therapy with (CRT-D) or without defibrillation (CRT-P) in non ischemic dilated cardiomyopathy (NIDCM) [1]. Of their 252 patients, 68 had left ventricular midwall fibrosis detected by cardiac magnetic resonance imaging (CMR). It was found that left ventricular midwall fibrosis was an independent predictor of total mortality, death from pump failure and sudden cardiac death. Maximum follow up period in their study was 14 years. They documented lower total mortality or hospitalization for major adverse cardiac events in those with CRT-D compared with CRT-P in those with left ventricular midwall fibrosis. This was not observed in those without left ventricular midwall fibrosis. The finding would favour usage of CRT-D over CRT-P in NIDCM with left ventricular mid wall fibrosis.

It was also noted that midwall fibrosis predicted total mortality, composite of total mortality and heart failure hospitalizations, cardiovascular mortality and a composite of total mortality or major adverse cardiovascular events [1]. Another important finding was that the association of mid wall fibrosis and total mortality was linked to pump failure as well as sudden cardiac death and hospitalization for ventricular arrhythmias. So the mid wall fibrosis was the factor associated with benefit of CRT-D over CRT-P.

Reference

  1. Leyva F, Zegard A, Acquaye E, Gubran C, Taylor R, Foley PWX, Umar F, Patel K, Panting J, Marshall H, Qiu T. Outcomes of Cardiac Resynchronization Therapy With or Without Defibrillation in Patients With Nonischemic Cardiomyopathy. J Am Coll Cardiol. 2017 Sep 5;70(10):1216-1227.