Sustained benefit of cardiac resynchronization therapy.
BACKGROUND
Most data on cardiac resynchronization therapy (CRT) are from trials with highly selected patients, with limited long-term echocardiographic data. This study was performed to evaluate long-term echocardiographic remodeling after CRT in daily practice.


RESULTS
A biventricular pacemaker was implanted in 130 patients with advanced heart failure who met the general accepted criteria for CRT or in heart failure patients with a conventional pacemaker indication. Two years echocardiographic follow-up was available. Mean age (73 years) was higher than in the randomized trials. Forty-one patients (32%) died during the 2 year follow-up period. Mortality was higher in males, in patients with increased NT-proBNP, renal dysfunction, or left atrial dilatation before implantation. Echocardiographic response (LVEF improvement of 5% or more) was documented in 69, 88, and 91% of the survivors, after 3 months, 1 year, and 2 years, respectively. Echocardiographic response after 3 months was associated with a significantly higher long-term survival (P = 0.04). Mean LVEF was 22% at baseline compared to 31.8, 38.3, and 39.7% after 3 months, 1 year, and 2 years, respectively (P < 0.01). Reverse remodeling (a reduction of LV end systolic volume of more than 10%) was observed in 70.7, 81.0, and 91.7% of the survivors after 3 months, 1 year, and 2 years, respectively. Long-term LV improvement was more pronounced in patients with nonischemic cardiomyopathy.


CONCLUSIONS
LV reverse remodeling and beneficial echocardiographic changes were sustained during 2 years follow-up. A 5% or more increase in LVEF after 3 months was associated with a better long-term survival.
Delnoy
Peter Paul H M
PP
Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands. v.r.c.derks@isala.nl
Ottervanger
Jan Paul
JP
Luttikhuis
Henk Oude
HO
Nicastia
Debbie M
DM
Elvan
Arif
A
Misier
Anand R Ramdat
AR
Beukema
Willem
W
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography; D020257:Ventricular Remodeling