Long-term reverse remodeling with cardiac resynchronization therapy: results of extended echocardiographic follow-up.

Abstract

OBJECTIVES:

The purpose of this study was to describe the long-term course of left ventricular remodeling induced by cardiac resynchronization therapy (CRT), adjusting for the confounding effect of patient loss due to disease.

BACKGROUND:

Reverse remodeling has been identified as the primary mechanism of improved symptoms and outcome in heart failure patients.

METHODS:

A total of 313 consecutive patients who underwent CRT with available baseline echocardiograms and subsequent clinical and echocardiographic follow-up were included in the analysis. Long-term follow-up included all-cause mortality, heart transplantation, and implantation of a left ventricular assist device. Longitudinal data analysis of left ventricular end-systolic volume index (LVESVi) was performed to adjust for the confounding effect of patient loss during follow-up.

RESULTS:

Patients with uneventful survival had a lower baseline LVESVi (Delta = 8.6 ml/m(2), SE = 4.6 ml/m(2), p < 0.0001) and a decreased LVESVi by -0.11 ml/m(2)/day during first 6 months, whereas the LVESVi remained unchanged in patients with adverse events (p < 0.0001). Beyond 6 months, the LVESVi remained unchanged in patients with uneventful survival, whereas the LVESVi continued to increase in those with adverse events at a rate of 0.01 ml/m(2)/day (p < 0.0001). Predictors of reverse remodeling were nonischemic etiology, female sex, and a wider QRS duration (p < 0.0001, p = 0.014, and p = 0.001, respectively). In the majority of patients, 6 months indicates a break point after which reverse remodeling becomes significantly less pronounced.

CONCLUSIONS:

CRT patients with uneventful survival show a significant decrease in the LVSVi at 6 months and generally maintain this response in the long term. Those with adverse outcomes are characterized by left ventricular dilation despite CRT.

• Authors: David Verhaert, Richard A Grimm, Chirapa Puntawangkoon, Kathy Wolski, Sabe De, Bruce L Wilkoff, Randall C Starling, W H Wilson Tang, James D Thomas, Zoran B Popović
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 55 Issue 17 Pg. 1788-95 (Apr 27 2010) ISSN: 1558-3597 [Electronic] United States
• PMID: 20413027 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Cardiac Pacing, Artificial (mortality)
• Defibrillators, Implantable
• Echocardiography
• Female
• Follow-Up Studies
• Heart Failure (physiopathology, therapy)
• Humans
• Male
• Middle Aged
• Ventricular Remodeling (physiology)