Volume 3, Number 1 - Heart Failure Society of America

Heart Failure Society News February 2001
4th Annual Scientific Meeting Coverage
Late-Breaking Clinical Trials Analyze New Data
MUltisite STimulation In Cardiomyopathy (MUSTIC)
Serge Cazeau, St. Cloud, France, reported on MUSTIC, the
first controlled trial to assess the efficacy and safety of
biventricular pacing in patients with severe chronic heart failure
and major electrical ventricular discoordination.
The study’s rationale was based on the prevalence of intraventricular
conduction disorders in the heart failure population
. The randomized, crossover, single-blinded design enrolled
patients in two groups. The 58 patients randomized in
group 1 had stable sinus rhythm and had no traditional indication
for pacing. The 46 patients in group 2 exhibited chronic
atrial fibrillation and slow ventricular rate, either spontaneous
or induced, and were randomized to biventricular or right
ventricular pacing. Enrollment criteria included severe heart
failure, stabilization in NYHA class for at least 1 month under
optimized drug treatment, LFEV 20), gender, and race. The primary endpoint was
all-cause mortality; the secondary endpoints were cardiovascular
mortality, hospitalizations, death or transplant,
ejection fraction, incidences of myocardial infarction, quality
of life, and the need for cotherapy.
The results indicate that compared to placebo, bucindolol
reduces plasma norepinephrine levels, improves LVEF at
3 and 12 months, reduces cardiovascular death by 14%,
reduces hospitalization by 12% reduction, and reduces
myocardial infarctions by 50%. The drug showed a nonsignificant
trend to reductions in hospitalization; reductions
in all-cause mortality, sudden death and pump death,
and non-cardiovascular death were not significant.
Dr. Eichhorn suggested that the absence of a statistically
significant reduction in the primary endpoint of all-cause
mortality could be attributed to a heterogeneous response
to the drug and to the inclusion of patients with class IV
heart failure. Specifically, African Americans had a 17%
increase in mortality and higher rates of hypertension. If
this subgroup is removed from the analysis, the remaining
2100 patients experienced statistically significant reductions
in all-cause mortality. “If patients with ejection fractions