Long-term prognosis after cardiac resynchronization therapy is related to the extent of left ventricular reverse remodeling at midterm follow-up.
OBJECTIVE
The aim of the current study was to evaluate the relation between the extent of left ventricular (LV) reverse remodeling and clinical/echocardiographic improvement after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome.


BACKGROUND
Despite the current selection criteria, individual response to CRT varies significantly. Furthermore, it has been suggested that reduction in left ventricular end-systolic volume (LVESV) after CRT is related to outcome.


METHODS
A total of 302 CRT candidates were included. Clinical status and echocardiographic evaluation were performed before implantation and after 6 months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for heart failure.


RESULTS
Based on different extents of LV reverse remodeling, 22% of patients were classified as super-responders (decrease in LVESV > or =30%), 35% as responders (decrease in LVESV 15% to 29%), 21% as nonresponders (decrease in LVESV 0% to 14%), and 22% negative responders (increase in LVESV). More extensive LV reverse remodeling resulted in more clinical improvement, with a larger increase in LV function and more reduction in mitral regurgitation. In addition, more LV reverse remodeling resulted in less heart failure hospitalizations and lower mortality during long-term follow-up (22 +/- 11 months); 1- and 2-year hospitalization-free survival rates were 90% and 70% in the negative responder group compared with 98% and 96% in the super-responder group (log-rank p value <0.001).


CONCLUSIONS
The extent of LV reverse remodeling at midterm follow-up is predictive for long-term outcome in CRT patients.
Ypenburg
Claudia
C
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
van Bommel
Rutger J
RJ
Borleffs
C Jan Willem
CJ
Bleeker
Gabe B
GB
Boersma
Eric
E
Schalij
Martin J
MJ
Bax
Jeroen J
JJ
D000368:Aged; D002304:Cardiac Pacing, Artificial; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling