Gaseous emissions at the site of the Delphic Oracle: assessing the ancient evidence.

摘要

There is consistency across the European and American guidelines1-5 in providing the Class I recommendation level with level of evidence A for cardiac resynchronization therapy (CRT) for patients with heart failure, New York Heart Association class functional Class III-IV symptoms, left ventricular dysfunction, and a wide QRS complex. I was surprised to read that Dr Coceani is not convinced that CRT deserves this strong recommendation for patients with these conventional criteria.5 Well-founded skepticism is to be admired. However, in this case it is undeserved. The evidence is irrefutable. In CARE-HF, which found a 40% relative risk reduction in the primary end point of all-cause death or cardiovascular hospitalization and a 52% reduction in heart failure hospitalizations, the number needed to treat to prevent a primary end point was 9.6 In cardiovascular medicine, it is unusual to demonstrate such powerful intervention strategies.