Predictors of remodeling in the CRT era: influence of mitral regurgitation, BNP, and gender.
BACKGROUND
We analyzed quantitative echocardiographic data from a large heart failure cohort receiving medical and cardiac resynchronization therapy (CRT) to determine baseline predictors of progressive left ventricular (LV) enlargement.


RESULTS
Quantitative echocardiograms were obtained at baseline and after 6 months in 776 outpatients with chronic heart failure who participated in MIRACLE (Multicenter InSync Randomized Clinical Evaluation) and MIRACLE-ICD (Multicenter InSync ICD Randomized Clinical Evaluation). We used multivariable regression to determine clinical, therapeutic, and echocardiographic characteristics that predicted a subsequent change in left ventricular end-diastolic volume (LVEDV). Over 6 months, LVEDV increased in 308 (40%) and decreased in 468 (60%) patients. Baseline mitral regurgitation and levels of plasma brain natriuretic peptide (BNP) independently predicted LV enlargement, whereas CRT predicted a decrease in LVEDV (all P < .01). In all models tested, male gender was an independent risk factor for progressive LV enlargement (P < .0001).


CONCLUSIONS
Men show more prominent LV dilation than women in chronic heart failure despite medical and device therapy. Rates of LV remodeling are influenced further by mitral regurgitation, plasma BNP, and CRT. Future studies should take these clinical factors into account when determining the influence of genetic factors and novel therapies on ventricular remodeling in chronic heart failure.
Cappola
Thomas P
TP
Division of Cardiovascular Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
Harsch
Manya R
MR
Jessup
Mariell
M
Abraham
William T
WT
Young
James B
JB
Petersen-Stejskal
Susan
S
Plappert
Ted
T
St John Sutton
Martin
M
D000368:Aged; D002304:Cardiac Pacing, Artificial; D006332:Cardiomegaly / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain; D012737:Sex Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D020257:Ventricular Remodeling
D020097:Natriuretic Peptide, Brain