Volume 3, Number 1 - Heart Failure Society of America

More documents

Recommendations

Info

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
Heart Failure Society News February 2001 4th Annual Scientific Meeting Coverage (continued from page 14) ences in cardiovascular disease,” he said. He suggested that the norepinephrine-lowering effect may have mitigated the benefits of the drug and maintained that there is a beneficial role for beta blockers. COPERNICUS Milton Packer provided the first American presentation of the results of the COPERNICUS trial, a prospective, placebo-controlled, randomized investigation of carvedilol in patients with advanced ischemic or non-ischemic heart failure. The trial randomized 2289 patients with ejection fractions
Page 1 and 2: An Official Publication of the Hear
Page 3 and 4: Heart Failure Society News February
Page 13: Heart Failure Society News February

Volume 3, Number 1 - Heart Failure Society of America

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?