Greater left ventricular reverse remodeling after 6 months of CRT was associated with higher 2-year hospitalization-free survival (96% in super-responders vs 70% in negative responders, P<0.001).
Cohort (n=302)
Does the extent of left ventricular reverse remodeling at 6 months after cardiac resynchronization therapy predict long-term mortality and heart failure hospitalizations in CRT candidates?
The extent of left ventricular reverse remodeling at 6 months after cardiac resynchronization therapy strongly predicts long-term hospitalization-free survival and mortality.
Absolute Event Rate: 96% vs 70%
p-value: p=<0.001
OBJECTIVES: 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 et al. (Sun,) conducted a cohort in Heart failure (CRT candidates) (n=302). Left ventricular reverse remodeling (decrease in LVESV) vs. Negative responders (increase in LVESV) was evaluated on 2-year hospitalization-free survival (p=<0.001). Greater left ventricular reverse remodeling after 6 months of CRT was associated with higher 2-year hospitalization-free survival (96% in super-responders vs 70% in negative responders, P<0.001).