Comparison of cardiac resynchronization therapy outcomes in patients with New York Heart Association functional class I/II versus III/IV heart failure

Alan J. Bank, Ariel Rischall, Ryan M. Gage, Kevin V. Burns, Spencer H. Kubo

Research output: Contribution to journalReview article

4 Scopus citations


Background: Several randomized trials have shown that cardiac resynchronization therapy (CRT) benefits New York Heart Association (NYHA) functional class I/II heart failure (HF) patients, but it is unknown if similar outcomes occur in the real-world. Methods and Results: All patients receiving CRT between 2003 and 2008 with ejection fraction (EF) ≤35% and QRS duration ≥120 ms were included. Outcomes assessed were subjective clinical response, echocardiographic response, and survival free of cardiovascular (CV) hospitalization. Baseline demographics in functional class I/II (n = 155) and functional class III/IV (n = 512) were similar, except for differences in age and several comorbidities. Clinical response was similar in both groups. The functional class I/II group had a greater decrease in left ventricular (LV) end-diastolic dimension (P =.031), and trended toward greater improvements in LV end-systolic dimension (P =.056) and EF (P =.059). The functional class I/II group had a better 5-year survival rate (79 vs 54%; P <.0001) and survival free of CV hospitalization (45% vs 26%; P <.0001). Conclusions: In this real-world clinical scenario, NYHA functional class I/II CRT patients improved clinical status, and LV function and size as good as or better than those in NYHA functional class III/IV patients. These observations provide further support for the use of CRT in patients with mild symptoms of HF.

Original languageEnglish (US)
Pages (from-to)373-378
Number of pages6
JournalJournal of Cardiac Failure
Issue number5
StatePublished - Jan 1 2012
Externally publishedYes



  • Cardiac resynchronization therapy
  • heart failure
  • NYHA functional classification
  • remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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