The magnitude of reverse remodelling irrespective of aetiology predicts outcome of heart failure patients treated with cardiac resynchronization therapy.
OBJECTIVE
We assessed the relationship between cardiac resynchronization therapy (CRT)-induced reverse remodelling and mortality during a long-term follow-up in a prospective observational study.


RESULTS
We analyzed data from a prospective registry including 398 consecutive patients who underwent CRT between September 1998 and September 2007. Left ventricular ejection fraction (LVEF) was assessed before CRT and in the period between 3 and 6 months following implant. All-cause mortality, urgent transplantation and implantation of left ventricular assist device were all considered relevant events. A total of 398 (179 non-ischaemic and 219 ischaemic) patients were analysed. Overall, the increase of LVEF was statistically significant and was computed with 7.0 points (95% CI 5.8-8.3, P < 0.001). Non-ischaemic patients had a larger increase [9.2 points (95% CI 7.0-11.1), P < 0.001] of their LVEF from baseline, when compared with the ischaemic group. The median duration of follow-up was 4.4 years. The cumulative incidence of all events at the end of the 96 months period of follow-up was 55% and it was 34% (95% CI 29-40) at 5 years. At the multivariable analysis of the event-free survival, aetiology lost its predictive value (HR 0.92, P = 0.47), while a change in LVEF >or=6 points still significantly decreased the risk of event during the follow-up (HR 0.30, P = 0.001).


CONCLUSIONS
Reverse remodelling measured by LVEF after 3 months is a good predictor of long-term outcome. Patients with an increase in LVEF >or=6 points have an excellent event-free survival approaching 66% at 5 years of follow-up.
Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USA.
Luigi
L
Di Biase
Angelo
A
Auricchio
Antonio
A
Sorgente
Kenneth
K
Civello
Catherine
C
Klersy
Francesco
F
Faletra
Lucie
L
Riedlbauchova
Dimpi
D
Patel
Mauricio
M
Arruda
Robert A
RA
Schweikert
David O
DO
Martin
Walid I
WI
Saliba
Tiziano
T
Moccetti
Bruce L
BL
Wilkoff
Andrea
A
Natale
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology*; D020257:Ventricular Remodeling / Q000502:physiology*