Health News: 2006

Electrocardiogram Helps Predict Risk for Congestive Heart Failure in Hypertensive Patients
An electrocardiogram (ECG) is an effective tool for detecting risk of congestive heart failure (CHF) in patients with hypertension, according to a new study by physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center published in today's journal Circulation: Journal of the American Heart Association. The findings may help increase early detection and treatment of CHF. An analysis of 8,696 hypertensive patients with no history of CHF found that a unique and well-known ECG wave pattern called strain was present in 923 patients (10.6 percent). These patients had a greater than threefold increased risk of developing CHF, with a five-year rate of 8.8 percent, compared with only 2.7 percent for those without ECG strain. Additionally, patients with strain had an exactly fourfold increased risk of CHF mortality, with a five-year CHF mortality of 1.2 percent, compared with only 0.3 percent in patients without strain. [more]


Clinical Trials in Cardiology

Cardiologists Participate in a Study to Reverse Deterioration in Heart Failure
Researchers in the Division of Cardiology at the Weill Medical College of Cornell University are participating in the REVERSE trial (REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction). REVERSE seeks to determine whether cardiac resynchronization therapy (CRT) can help limit the downward spiral of heart failure in people who have mild or even no symptoms but poor heart pumping function. Previously, CRT has been shown to reduce symptoms, improve exercise capacity, and prolong survival in people with more advanced forms of heart failure.

Cardiac resynchronization therapy helps resynchronize the beating of the heart, and is proven to improve symptoms and prolong life in patients with moderate-to-severely symptomatic heart failure. Trial investigators will implant CRT pacemakers or CRT defibrillators in more than 500 patients at approximately 100 centers in Europe, the United States, and Canada. On a randomized basis, two-thirds of the participants will have CRT turned on, and the other one-third will have CRT turned off to serve as a control group. All patients in the study will receive optimal drug therapy and will be followed for at least a year. At the end of the follow-up period, patients in the control group will begin receiving CRT therapy. All patients involved in the trial have a broad range of underlying causes for their heart failure, including those with and without a previous heart attack or coronary heart disease. Eligible patients must have an abnormal electrocardiogram that demonstrates a wide QRS complex.

The protocol of the REVERSE trial has been approved by the U. S. Food and Drug Administration under an Investigational Device Exemption. The primary endpoint of the study is a clinical composite score that measures key outcomes such as mortality, hospitalization for worsening heart failure, quality of life and symptoms. Secondary endpoints include changes in the size of enlarged hearts and costs to the healthcare system.

For more information contact the Cardiac Electrophysiology Laboratory: 212-746-4857.


Research Study at Weill Cornell to Determine if More Patients Benefit from Cardiac Resynchronization
Researchers in the Division of Cardiology at the Weill Medical College of Cornell University are participating in the ReThinQ clinical trial (Resynchronization Therapy in Normal QRS). RETHINQ study is designed to evaluate the safety and efficacy of cardiac resynchronization therapy in patients with advanced heart failure and echocardiographic evidence of mechanical dyssynchrony (uncoordinated contraction of the lower chambers of the heart) who do not currently qualify for device therapy by virtue of having a narrow QRS complex on a standard electrocardiogram.

Cardiac resynchronization therapy helps resynchronize the beating of the heart, and is proven to improve symptoms and prolong life in patients with moderate-to-severely symptomatic heart failure who have a wide QRS complex on a standard electrocardiogram. Current eligibility requirements for implanting a CRT system focus on ejection fractions of <35% (the amount of blood the heart pumps with each beat from the ventricle), NYHA Class (severity of heart failure symptoms) and QRS duration (measurement of the heart's electrical dyssynchrony). The RETHINQ study moves a step further in defining dyssynchrony by looking at the degree of actual uncoordinated pumping actions of the heart. It combines standard echocardiography evaluations with tissue Doppler imaging (TDI) which allows direct visualization and measurement of the heart's impaired function due to mechanical dyssynchrony. Patients with a narrow QRS are currently not indicated for CRT, and echo/TDI criteria may be a better predictor of which patients will respond to resynchronization therapy.

This prospective, randomized, double-blind clinical study will enroll about 218 patients and be conducted at approximately 40 clinical centers. The protocol of the ReThinQ trial has been approved by the U. S. Food and Drug Administration under an Investigational Device Exemption.

For more information contact the Cardiac Electrophysiology Laboratory: 212-746-4857.