The advent of cardiac resynchronization therapy has created a confusing terminology of heart failure

Three recent trials (Resynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction [REVERSE], MADIT-CRT, and Resynchronization-Defibrillation for Ambulatory Heart Failure [RAFT]) [1–3] have demonstrated the benefit of cardiac resynchronization therapy (CRT) in a relatively large number of New York Heart Association (NYHA) class II heart failure (HF) patients with a wide QRS complex, and a much smaller NYHA class I group of asymptomatic patients with severe left ventricular (LV) dysfunction also with a wide QRS complex. These trials generated a large number of substudies, meta-analyses and review articles about CRT in NYHA asymptomatic class I patients and class II HF patients and fostered the expansion of indications for CRT. The large number of publications about CRT has created or reactivated problems with the terminology of HF a situation compounded by the common misinterpretation of the NYHA classification [4]. The following descriptions from recent publications illustrate how confusing the terminology of HF has become. Descriptions such as “severe”, “chronic” and “refractory” used alone are excluded. 1. HF with mild symptoms. Also “…mildly symptomatic patients with heart failure”. This terminology is acceptable but the definition of mild symptoms is missing. Presumably it refers to functional class II NYHA, but not class I [4–6].