The effect of cardiac resynchronization therapy (CRT) on EF improvement in heart failure patients base of patients’ sex

Document Type : Original Article


1 Cardiology Resident, Department of Cardiology, School of Medicine, Atherosclerotic Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Assistant Professor, Department of Cardiology, School of Medicine, Atherosclerotic Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran

3 - Assistant Professor of Clinical Cardiac Electrophysiology, Department of Cardiology, School of Medicine, Jundishapur University of Medical sciences, Ahvaz, Iran


Introduction: Heart failure is a serious public health problem that leads to frequent hospitalization, reduced quality of life and death. Cardiac resynchronization therapy (CRT) is wealth treatment for heart failure diseases but rate of no response is high.
Objective: To evaluate the effect of CRT on EF improvement in heart failure patients base of patients’ sex.
Methods: The present study is clinical trial, before and after the intervention, which has been performed on 21 heart failure patients with CRT admitted to Imam Khomeini Hospital of Ahvaz in 2019. Demographic and clinical characteristics of patients were assessed and recorded, and all patients underwent 3D echocardiography before and 2-3 weeks after CRT to assess response to treatment. In all subjects, left ventricular EF were measured when the CRT was switched off and also after switching on the device.
Results: The study subjects were included 12 men (57.1%) and 9 women (42.9%) with a mean age of 64.57±9.99 years. The results showed that the MR intensity index score decreased significantly after the intervention (P=0.002). The mean EF changes before and after CRT intervention were not significant based on patient’s gender (P=0.754) and age (P=0.617).
Conclusions: The results of this study revealed that CRT treatment in patients with heart failure causes a positive clinical response by increasing EF. Moreover, the effect of this treatment and EF changes is independent of patients age and gender.
Keywords: heart failure, cardiac resynchronization therapy, Left Ventricular EF, echocardiography


1-Pillai HS, Ganapathi S. Heart Failure in South Asia. Curr Cardiol Rev. 2013;9(2):102–11.
2-Liu L, clinics HE-C, 2014  undefined. Epidemiology of heart failure and scope of the problem. [Internet]. [cited 2020 Apr 7]; Available from:
3-Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol. 2014;63(12):1123–33.
4-Shimokawa H, Miura M, Nochioka K, Sakata Y. Heart failure as a general pandemic in Asia. Eur J Heart Fail. 2015;17(9):884–92.
5-Ahmadi A, Etemad K, Khaledifar A. Risk factors for heart failure in a cohort of patients with newly diagnosed myocardial infarction: a matched, case-control study in Iran. Epidemiol Health. 2016;38.
6-Asgar AW, Mack MJ, Stone GW. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations. J Am Coll Cardiol. 2015;65(12):1231–48.
7-Bagherzade AA, Tavakoli T, Moshkani Farahani M. The acute effects of cardiac resynchronization therapy on severity of mitral regurgitation in end-stage heart failure patients. Tehran Univ Med J. 2011; 69 (5) :279-282. [Persian]
8-Marek J, Gandalovičová J, Kejřová E, Pšenička M, Linhart A, Paleček T. Echocardiography and cardiac resynchronization therapy. Cor Vasa. 2016;58(3):e340–51.
9-Linde C, Abraham WT, Gold MR, Sutton MSJ, Ghio S, Daubert C, et al. Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J Am Coll Cardiol. 2008;52(23):1834–43.
10-Spartalis M, Tzatzaki E, Spartalis E, Damaskos C, Athanasiou A, Livanis E, et al. The role of echocardiography in the optimization of cardiac resynchronization therapy: current evidence and future perspectives. Open Cardiovasc Med J. 2017;11:133.
11-Pires LA, Abraham WT, Young JB, Johnson KM, Investigators M and M-I. Clinical predictors and timing of New York Heart Association class improvement with cardiac resynchronization therapy in patients with advanced chronic heart failure: results from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Multice. Am Heart J. 2006;151(4):837–43.
12-Kapetanakis S, Bhan A, Murgatroyd F, Kearney MT, Gall N, Zhang Q, et al. Real-time 3D echo in patient selection for cardiac resynchronization therapy. JACC Cardiovasc Imaging. 2011;4(1):16–26.
13-Wang H, Shuraih M, Ahmad M. Real time three‐dimensional echocardiography in assessment of left ventricular dyssynchrony and cardiac resynchronization therapy. Echocardiography. 2012;29(2):192–9.
14-Committee 2009 Writing Group to Review New Evidence and Update the 2005 Guideline for the Management of Patients with Chronic Heart Failure Writing on Behalf of the 2005 Heart Failure Writing, Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, et al. 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with t. Circulation. 2009;119(14):1977–2016.
15-Hotta VT, Martinelli Filho M, Mady C, Mathias Jr W, Vieira ML. Comparison between 2D and 3D echocardiography in the evaluation of reverse remodeling after CRT. Arq Bras Cardiol. 2011;97(2):111–21.
16-Nesser H-J, Mor-Avi V, Gorissen W, Weinert L, Steringer-Mascherbauer R, Niel J, et al. Quantification of left ventricular volumes using three-dimensional echocardiographic speckle tracking: comparison with MRI. Eur Heart J. 2009;30(13):1565–73.
17-Bakhshian Kelarijani R, Kalantar Motamedi MH, Kalani P. Evaluating changes of Function class, electrocardiography and echocardiography before and after biventricular pacing. Annals Mil Heal Sci Res. 2008; 6(2):135–9. [Persian]
18-Feldman DS, Mohacsi P. Heart Failure. Springer; 2019.
19-Kuppahally SS, Fowler MB, Vagelos R, Wang P, Al-Ahmad A, Hsia H, et al. Dyssynchrony assessment with tissue doppler imaging and regional volumetric analysis by 3D echocardiography do not predict long-term response to cardiac resynchronization therapy. Cardiol Res Pract. 2011;2011.
20-Soliman OII, Geleijnse ML, Theuns DAMJ, van Dalen BM, Vletter WB, Jordaens LJ, et al. Usefulness of left ventricular systolic dyssynchrony by real-time three-dimensional echocardiography to predict long-term response to cardiac resynchronization therapy. Am J Cardiol. 2009;103(11):1586–91.
21-Cho I-J, Uhm J-S, Oh J, Nam J-H, Yu HT, Kim T, et al. Left ventricular response after cardiac resynchronization therapy is related to early left atrial volume reduction. Korean J Intern Med. 2020 Feb;0(0):0.
22-Sonne C, Sugeng L, Takeuchi M, Weinert L, Childers R, Watanabe N, Yoshida K, Mor-Avi V, Lang RM. Real-time 3-dimensional echocardiographic assessment of left ventricular dyssynchrony: pitfalls in patients with dilated cardiomyopathy. JACC: Cardiovascular Imaging. 2009;2(7):802-12.
23-Cipriani M, Ammirati E, Landolina M, et al. Cumulative analysis on 4802 patients confirming that women benefit more than men from cardiac resynchronization therapy. Int J Cardiol. 2015;182C:454–6.
24-Ruschitzka F, Abraham WT, Singh JP, et al. Cardiacresynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med. 2013;369:1395-1405.
25-Zusterzeel R, Selzman KA, Sanders WE, et al. Cardiac resynchronization therapy in women: US Food and Drug Administration meta-analysis of patient-level data. JAMA Intern Med. 2014;174:1340–8.
26-Cleland JG, Abraham WT, Linde C, et al. An individual patient metaanalysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. European heartjournal. 2013;34(46):3547-3556.