Key result
CRT links to ~126% higher LV reverse remodeling odds despite severe dilatation, improving 10-year survival.
Why the study?
Left ventricular dilatation may limit left ventricular reverse remodeling after cardiac resynchronization therapy, and its impact on reverse remodeling and survival needed evaluation.
Does cardiac resynchronization therapy induce left ventricular reverse remodeling and improve survival in heart failure patients regardless of baseline left ventricular dilatation?
Observational (n=864)
No
Does cardiac resynchronization therapy induce left ventricular reverse remodeling and improve survival in heart failure patients regardless of baseline left ventricular dilatation?
Effect estimate: OR 2.256 (95% CI 1.259-4.043)
Absolute Event Rate: 64% vs 45%
p-value: p=0.006
Patients with severe baseline left ventricular dilatation can still achieve significant reverse remodeling and improved long-term survival after CRT, indicating severe dilatation should not preclude CRT implantation.
BACKGROUND: Left ventricular (LV) dilatation may limit LV reverse remodeling after cardiac resynchronization therapy (CRT). OBJECTIVE: The purpose of this study was to evaluate the impact of baseline LV volumes on LV reverse remodeling after CRT and whether this is associated with improved survival. METHODS: Patients were stratified into quintiles according to baseline LV end-diastolic volume indexed for body surface area (LVEDVi). LV reverse remodeling was defined as ≥15% reduction in LV end-systolic volume at 6-month follow-up after CRT. Independent associates of LV remodeling were assessed and long-term mortality rates were compared between patients with and without LV reverse remodeling (across LVEDVi quintiles). Patients with larger baseline LVEDVi had worse survival after CRT (log-rank, P = .019). The cumulative 10-year survival was significantly better in patients with vs without LV reverse remodeling (48.7% vs 33.9%; P < .001). Significant LV reverse remodeling was observed in all LVEDVi quintiles. In addition, patients with LV reverse remodeling had superior survival than did patients without LV reverse remodeling, regardless of baseline LVEDVi quintile (log-rank, P < .05 for all). CONCLUSION: Many patients with larger baseline LV volumes still show significant LV reverse remodeling after CRT and had superior survival (regardless of baseline LV volumes) than did patients without LV reverse remodeling. Therefore, CRT should not be denied on the basis of severe LV dilatation.
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Galloo et al. (2022) conducted an observational in Heart failure with reduced ejection fraction (n=864). Cardiac resynchronization therapy vs. Baseline LVEDVi <65 mL/m2 (Quintile 1) was evaluated on Left ventricular reverse remodeling (≥15% reduction in LV end-systolic volume) at 6 months (OR 2.256, 95% CI 1.259-4.043, p=0.006). Cardiac resynchronization therapy induced significant left ventricular reverse remodeling even in patients with severe baseline dilatation, which was associated with improved 10-year survival (48.7% vs 33.9%, P<0.001).
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