Biventricular Cardiac Resynchronization in Moderate-to-Severe Heart Failure: Analysis of Hospital Costs and Clinical Effectiveness (Brescia Study)

Heart failure is a chronic condition of complex physiopathologic origin which involves escalating clinical costs [1-3]. Cardiac resynchronization therapy is a novel treatment for the one in every six heart failure patients whose condition is refractory to optimized drug treatment, with evidence of ventricular dysynchrony which leads to a deterioration of hemodynamics and a higher risk of death [4-7]. In such hearts the regions which activate in advance will experience or receive a lower afterload, and the rapid presystolic contraction does not convert into a rise in pressure, because the other parts of the myocardium are still inactive. As a consequence, most myocardial activity is wasted in transferring the ejection from one part of the heart to another. This results in a lengthening of the ventricular pre-ejection period, a reduction of the contraction and the relaxation period, a reduction of the ejection fraction, and a rise in mitral regurgitation.