title: The effect of reverse remodeling on long-term survival in mildly symptomatic patients with heart failure receiving cardiac resynchronization therapy: results of the REVERSE study.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) reduces mortality, improves functional status, and induces reverse left ventricular remodeling in selected populations with heart failure (HF). The magnitude of reverse remodeling predicts survival with many HF medical therapies. However, there are few studies assessing the effect of remodeling on long-term survival with CRT.
  
  
  OBJECTIVE
  The purpose of this study was to assess the effect of CRT-induced reverse remodeling on long-term survival in patients with mildly symptomatic heart failure.
  
  
  METHODS
  The REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction trial was a multicenter, double-blind, randomized trial of CRT in patients with mild HF. Long-term follow-up of 5 years was preplanned. The present analysis was restricted to the 353 patients who were randomized to the CRT ON group with paired echocardiographic studies at baseline and 6 months postimplantation. The left ventricular end-systolic volume index (LVESVi) was measured in the core laboratory and was an independently powered end point of the REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction trial.
  
  
  RESULTS
  A 68% reduction in mortality was observed in patients with ≥15% decrease in LVESVi compared to the rest of the patients (P = .0004). Multivariable analysis showed that the change in LVESVi was a strong independent predictor (P = .0002), with a 14% reduction in mortality for every 10% decrease in LVESVi. Other remodeling parameters such as left ventricular end-diastolic volume index and ejection fraction had a similar association with mortality.
  
  
  CONCLUSIONS
  The change in left ventricular end-systolic volume after 6 months of CRT is a strong independent predictor of long-term survival in mild HF.
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina. Electronic address: goldmr@musc.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Gold
authors.affiliation: Department of Cardiology, University Hospital, Rennes, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Daubert
authors.affiliation: The Ohio State University, Columbus, Ohio.
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.affiliation: University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.
authors.forename: Martin
authors.initials: M
authors.lastname: St John Sutton
authors.affiliation: Medtronic Inc, Minneapolis, Minnesota.
authors.forename: John Harrison
authors.initials: JH
authors.lastname: Hudnall
authors.affiliation: Medtronic Inc, Minneapolis, Minnesota.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cerkvenik
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Linde
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D004311:Double-Blind Method; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D017741:Survivors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020257:Ventricular Remodeling
keywords: Cardiac resynchronization therapy; Defibrillator; Heart failure; Implantable cardioverter-defibrillator; Remodeling