International Circulation: There have been recent recommendations about the use of CRT for Class III and IV with certain EF qualifications and QRS qualifications. Are we looking at a progression whereby CRT might be becoming a standard treatment for those with severe left heart failure?
　　《国际循环》：有关CRT用于有特定EF条件和QRS条件的III级和IV级心力衰竭已经有了最新的推荐。我们是否是在寻求这样一个进展，CRT藉此可能会成为严重左心衰竭患者的标准治疗？
　　Dr Packer: If you look at the early trials (CONTAK， MU SIC， PATH-CHF and MIRACLE)， those were Class III and IV. If you examine those trials， the benefit for Class III and IV has already been established. The categories where things have changed are Class II and III， where the studies have shown that there is evidence now that Class II and even Class I receive benefit. So is there a progression from just III and IV to Classes II and III or in fact further to II and I? If the ejection fraction is low， and the QRS duration is above 130， then there is a benefit that is reasonable. If the QRS is not very wide， then it is not reasonable. The bigger question is: what do you do with the Class IV? When bridging to transplant， CRT may be very beneficial there， but now there is a move towards LVAD implantation. So LVADs are a bigger deal for Class IV. That is where the change is coming.
　　Dr Packer：如果你看一下早期的试验（CONTAK、MU SIC、PATH- CHF和MIRACLE），那些是III级和IV级心力衰竭。如果你审视这些试验，会发现对III级和IV级的益处已经得到证实。事情发生了变化的分类是II级和III级，研究对此已经证明，现在有证据显示II级甚至I级可获得收益。那么，是否有从III级和IV级向II级和III级的进展，或者实际上进一步到II级和I级？如果射血分数低且QRS时限大于130，那么有益处是合乎情理的。如果QRS不是很宽，那么就是不合理的。更大的问题是：对IV级你能采取什么措施？在向移植过渡时，CRT可能是非常有益的，但现在有朝LVAD植入方向发展。因此，对IV级心力衰竭，LVADs是更为重要的事情。这就是即将到来的变化。