076 Long term effects of cardiac resynchronization therapy in chronic heart failure patients.

Cardiac resynchronization therapy (CRT) is an effective treatment of advanced heart failure (HF). Recent studies showed a positive effect of CRT on HF symptoms, left ventricular ejection function (EF,%), reduction of hospitalizations and survival. However, most studies evaluated clinical and echocardiographic response to CRT after a limited follow-up (ranging from 6 to 12 months). Thus we evaluated clinical and functional response to CRT in HF patients (pts) after a longer follow-up period (up to 3 years, ys). We enrolled 75 HF outpts with CRT indication [30% females, mean age 67.9±12.6 ys, mean NYHA class 2.8±0.7, mean EF 25.7±8.1, HF aetiology: 44% coronary artery disease (CAD), 43% dilated cardiomyopathy (DCM), 6% hypertensive cardiomyopathy (HT), 7% valvular disease (V)]. All were evaluated by means of ECG, echocardiography, NYHA functional class before CRT device implant and re-evaluated after 1 (95% of pts), 2 (80% of pts), and 3 (45% of pts) ys. After 1 y, NYHA significantly improved (from 2.8±0.7 to 2.3±0.6, p<0.0001), as well as EF (from 25.7±8.1 to 30.1±9.0, p=0.005). This improvement was maintained after 2 ys (NYHA 2.3±0.6, EF 31.8±9.4) and 3 ys (NYHA 2.2±0.6, EF 33.4±10.2). Overall, we registered 8 deaths, of which 2 (2.7%) after 1 y, 3 (4%) after 2 ys and 3 (4%) after 3 ys. Dividing pts on the basis of HF aetiology, after 1 y all pts presented a significant improvement, while further on DCM pts showed a steady increase of EF (basal 22.9±7.8, after 1 y 28.8±9.5, after 2 ys 31.3±11.1 and after 3 ys 35.4±13.3), while CAD pts showed stabilization of EF on the first y values (basal 26.3±7.3, after 1 y 29.5±7.4, after 2 ys 29.7±6.3 and after 3 ys 29.9±5.2). Echocardiographic response to CRT in terms of EF is clearly evident after 1 y and remains improved after 2 and also 3 ys, with a not significant trend to further improve in DCM. All pts significantly improved NYHA within the first y. Benefit deriving from CRT is maintained during long term follow-up. [Copyright &y& Elsevier]