Heart failure & cardiomyopathiesSecondary analysis
Upgrading Right Ventricular Pacing to Cardiac Resynchronization in Heart Failure with Reduced Ejection Fraction (HFrEF) Patients Improves Symptoms and Functional Outcomes
- Secondary analysis of the BUDAPEST-CRT Upgrade randomised trial
- prespecified tertiary endpoints
Authors' conclusion
HFrEF patients with pacemaker/ICD and ≥20% RV pacing burden receiving CRT upgrade showed a substantial improvement in NYHA functional class and decrease in natriuretic peptide levels, as compared with ICD alone. Moreover, CRT-D upgrade could moderate the progression of worsening of QoL attributed to ageing in this vulnerable, elderly patient population.
Study context
- Population
- HFrEF patients with pacemaker or implantable cardioverter-defibrillator (ICD) and ≥20% right ventricular (RV) pacing burdenrandomised 3:2
- Participants
- 360 patients
- Comparison
- Cardiac resynchronization therapy with defibrillator (CRT-D) upgrade vs ICD
- CRT-D upgraden = 215
- ICDn = 145reference
- Primary endpoint
- Changes in quality of life (QoL) (EQ-5D-3L), NYHA class, 6-minute walk test and NT-proBNP (prespecified tertiary endpoints)
- Follow-up
- Up to 12 months
Primary result
As reported in the abstract
NYHA class, NT-proBNP, QoL (EQ-5D-3L), 6-minute walk test (prespecified tertiary endpoints)
CRT-D upgrade vs ICDAdjusted odds ratio (95% CI)P value
NYHA functional class improved with CRT-D upgrade
0.50(0.32–0.80)
P = 0.003CRT-D upgrade vs ICDEQ-5D-3L difference by each year (95% CI)P value
age-related worsening of QoL moderated by CRT-D upgrade
0.015(0.005–0.025)
P = 0.003for interaction- NT-proBNP decrease in the CRT-D arm, adjusted difference −1,257 pg/mL (95% CI −2,287 to −228 pg/mL)
- P = 0.017
Original publication
Upgrading Right Ventricular Pacing to Cardiac Resynchronization in HFrEF Patients Improves Symptoms and Functional Outcomes. JACC Heart Fail. Published 27 November 2024. doi:10.1016/j.jchf.2024.09.011
Summarised from the published abstract; every number is checked against it