title: Optimal cut-off value of reverse remodeling to predict long-term outcome after cardiac resynchronization therapy in patients with ischemic cardiomyopathy.
abstract: Whether the optimal cut-off value of left ventricular (LV) reverse remodeling is different in patients with ischemic cardiomyopathy (ICM) vs. non-ischemic cardiomyopathy (NICM) is unclear. This study aimed to clarify this value in patients with ICM and NICM.
  
  
  
  LV reverse remodeling was defined as a reduction in LV end-systolic volume (LVESV) at 6 months after cardiac resynchronization therapy (CRT). The clinical endpoint was the combination of cardiac death and first hospitalization for worsening heart failure. Ninety-one of 372 patients had ICM. Event-free survival rates did not differ between ICM and NICM groups (66.8% vs. 78.9%; p=0.12). Receiver operating characteristics analysis revealed a 9% reduction in ESV as the optimal cut-off value to predict the composite endpoint in patients with ICM and a 15% reduction in patients with NICM. Multivariate analysis revealed that reductions in ESV of ≥15% and ≥9% were independent predictors of the composite endpoint, as were left bundle branch block (LBBB) and B-type natriuretic peptide (BNP) at 6 months after CRT. In combination with LBBB and BNP, reduction in ESV ≥9% had a higher, but not significant, C-statistics value than ESV ≥15% (0.854, 95% CI 0.729-0.940 vs. 0.801, 95% CI 0.702-0.908, p=0.07).
  
  
  
  The optimal cut-off value of a reduction in LVESV was lower in patients with ICM than in patients with NICM.
authors.affiliation: Cardiovascular Division, Graduate School of Comprehensive Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sugano
authors.affiliation: Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. Electronic address: yo-seo@md.tsukuba.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Seo
authors.affiliation: Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Cardiovascular Division, Graduate School of Comprehensive Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Harimura
authors.affiliation: Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Machino-Ohtsuka
authors.affiliation: Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ishizu
authors.affiliation: Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy; D009202:Cardiomyopathies / Q000401:mortality / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012189:Retrospective Studies; D013599:Systole; D020257:Ventricular Remodeling
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Cardiac resynchronization therapy; Ischemic cardiomyopathy; Reverse remodeling