The impact of cardiac resynchronization therapy with implantable cardioverter defibrillators on patients with moderate to severe chronic heart failure: A single-arm clinical trial

Background: Patients with moderate to severe chronic heart failure (CHF) are at high risk for cardiac mortality. Cardiac resynchronization therapy with defibrillators (CRT-D) as a potentially beneficial option can improve the clinical outcomes of such patients. Methods: We conducted a single-arm clinical trial in which 48 patients with moderate to severe CHF were investigated regarding the beneficial outcome of CRT-D insertion. All participants were evaluated regarding different functional and echocardiographic factors including New York Heart Association (NYHA) functional class (FC), left ventricular ejection fraction (LVEF), mitral regurgitation (MR) as well as left ventricular end-systolic (LVESD) and end-diastolic (LVEDD) before and one month after the procedure. Furthermore, we investigated the influence of different variables including age, gender, and comorbidities on the aforementioned clinical and echocardiographic factors. Results: Of the 48 CHF patients included in our study, 24 (50%) were males and 24 (50%) were females. The mean ± standard deviation (range) of the participants’ age was 55.6±6.5 (40-69) years. CRT-D insertion significantly improved all functional and echocardiographic factors in CHF patients. The participants had a mean±standard deviation (range) LVEF of 22.1±5.8% (10-30%) before CRT-D insertion. A follow-up echocardiography performed one month after the implantation of CRT-D demonstrated a significant increase in LVEF to 27.1±5.5% (15-38%) (p<0.001). Additionally, echocardiography conducted one month after CRT-D insertion showed a reduction of LVESD from 6.8±0.5 cm (5.8-7.4 cm) to 6.2±0.5 cm (5.3-7.3 cm) (p<0.001). Conclusion: There is prominent evidence for CRT-D insertion in reducing symptoms of heart failure as well as improving different echocardiography variables in patients with moderate to severe CHF.