(NVKP-16-1-2016-0017 National Heart Program) Támogató: NKFIH
Nemzeti Kardiovaszkuláris Laboratórium(RRF-2.3.1-21-2022-00003) Támogató: NKFIH
(TKP2021-NVA-12) Támogató: Innovációs és Technológiai Minisztérium
(TKP2021-NVA)
Szakterületek:
Orvos- és egészségtudomány
Szív és keringési rendszer
In the BUDAPEST (Biventricular Upgrade on left ventricular reverse remodeling and
clinical outcomes in patients with left ventricular Dysfunction and intermittent or
permanent APical/SepTal right ventricular pacing)-CRT Upgrade randomized trial, the
authors have demonstrated improved mortality and morbidity after cardiac resynchronization
therapy (CRT) upgrade in patients with heart failure with reduced ejection fraction
(HFrEF) with high right ventricular (RV) pacing burden.This substudy sought to examine
the impact of CRT upgrade on symptoms, functional outcome, and exercise capacity.In
the BUDAPEST-CRT Upgrade trial, 360 HFrEF patients with pacemaker or implantable cardioverter-defibrillator
(ICD) and ≥20% RV pacing burden were randomly assigned (3:2) to cardiac resynchronization
therapy with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). The prespecified
tertiary endpoints were changes in quality of life (QoL) (EQ-5D-3L), NYHA functional
class, 6-minute walk test, and N-terminal pro-B-type natriuretic peptide (NT-proBNP)
levels.Up to 12 months, NYHA functional class improved in the CRT-D upgrade arm compared
with ICD only (adjusted OR: 0.50 [95% CI: 0.32-0.80]; P = 0.003). A remarkable decrease
was observed in NT-proBNP levels in the CRT-D arm (adjusted difference -1,257 pg/mL
[95% CI: -2,287 to -228]; P = 0.017). The progression of age-related worsening of
QoL was moderated by CRT-D upgrade (EQ-5D-3L difference by each year: 0.015 [95% CI:
0.005-0.025]; P interaction = 0.003). However, exercise tolerance (6-minute walk test)
remained unchanged in both groups.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. (Biventricular Upgrade on left ventricular
reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction
and intermittent or permanent APical/SepTal right ventricular pacing [BUDAPEST]-CRT
Upgrade trial).
