title: Prognostic value of left ventricular reverse remodeling and performance improvement after cardiac resynchronization therapy: A prospective study.
abstract: BACKGROUND
  The present study was designed to evaluate the respective value of left ventricular (LV) reverse remodeling (changes in LV end-systolic volume relative to baseline (ΔLVESV)) or LV performance improvement (ΔLV ejection fraction (ΔLVEF) or ΔGlobal longitudinal strain (GLS)) to predict long-term outcome in a prospective cohort of consecutive patients receiving routine cardiac resynchronization therapy (CRT).
  
  
  METHODS
  One hundred and seventy heart failure patients (NYHA classes II-IV, LVEF ≤ 35%, QRS width ≥ 120 ms) underwent echocardiography before and 9 months after CRT. The relationships between ΔLVESV, ΔLVEF, ΔGLS and outcome (all-cause mortality and/or CHF hospitalization, overall mortality, cardiovascular mortality, CHF hospitalization) were investigated.
  
  
  RESULTS
  During a median follow-up of 32 months, 20 patients died and 27 were hospitalized for heart failure. ΔLVESV, ΔLVEF or ΔGLS were significantly associated with all-cause mortality or CHF hospitalization (adjusted hazard's ratio (HR) per standard deviation 0.58 (0.43-0.77), 0.39 (0.27-0.57) or 0.55 (0.37-0.83) respectively, all p < 0.01) and all other endpoints (all p < 0.01). Patients with ΔLVESV≥15%, ΔLVEF ≥ 10% and ΔGLS ≥ 1% had a reduced risk of mortality or CHF hospitalization (adjusted HR=0.25 (0.12-0.51), p < 0.001, adjusted HR = 0.26 (0.13-0.54), p < 0.001 and adjusted HR 0.38 (0.19-0.75), p = 0.006 respectively). Overall performance of multivariate models was better using ΔLVESV or ΔLVEF compared with ΔGLS. Interobserver agreement was excellent for ΔLVESV (Intraclass correlation coefficient - ICC-0.91) and ΔGLS (ICC 0.90) but modest for ΔLVEF (ICC 0.76) in a sample of 20 patients from the study population.
  
  
  CONCLUSIONS
  LV reverse remodeling assessed by ΔLVESV is a strong and reproducible predictor of outcome following CRT. Compared with ΔLVESV, ΔLVEF and ΔGLS have important shortcomings: poorer reproducibility or lower predictive value.
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France; INSERM U 1088, Université de Picardie, Amiens, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Menet
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Guyomar
authors.affiliation: Cardiology Department, CHU de Grenoble, Grenoble, France.
authors.forename: Pierre-Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Graux
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Anne Laure
authors.initials: AL
authors.lastname: Castel
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Delelis
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Heuls
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Cuvelier
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Gevaert
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Le Goffic
authors.affiliation: Pôle Cardiovasculaire et Thoracique, Centre Hospitalier Universitaire Amiens, Amiens, France; INSERM U 1088, Université de Picardie, Amiens, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.affiliation: Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France; INSERM U 1088, Université de Picardie, Amiens, France. Electronic address: sylvestre.marechaux@yahoo.fr.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000401:mortality / Q000639:trends*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Cardiac resynchronization therapy; Global longitudinal strain; Heart failure; Prognosis