Key result
CRT yields similar rates of death and HF hospitalization in ischemic vs non-ischemic cardiomyopathy.
Why the study?
Patients with non-ischemic cardiomyopathy generally exhibit more pronounced reverse remodeling after cardiac resynchronization therapy than patients with ischemic cardiomyopathy, leaving the prognostic impact of CRT in ischemic cardiomyopathy uncertain.
Does cardiac resynchronization therapy (CRT-P/CRT-D) result in comparable composite outcomes of all-cause mortality and heart failure hospitalization in patients with ischemic cardiomyopathy compared to those with non-ischemic cardiomyopathy?
Cohort (n=83)
No
Does cardiac resynchronization therapy (CRT-P/CRT-D) result in comparable composite outcomes of all-cause mortality and heart failure hospitalization in patients with ischemic cardiomyopathy compared to those with non-ischemic cardiomyopathy?
Although patients with ischemic cardiomyopathy exhibit less pronounced structural reverse remodeling following CRT than those with non-ischemic cardiomyopathy, their long-term clinical outcomes and survival are comparable, supporting systematic CRT use across both etiologies.
Comparable composite outcomes after CRT by cardiomyopathy etiology; leaves open etiology-specific effects in larger prospective cohorts.
Patients with non-ischemic cardiomyopathy (NICM) generally exhibit better responses to cardiac resynchronization therapy (CRT) due to more pronounced reverse remodeling compared to ischemic cardiomyopathy (ICM) patients. However, the prognostic impact of CRT in ICM patients remains uncertain. This study aimed to evaluate the impact of heart failure (HF) etiology on reverse remodeling, clinical outcomes, and survival following CRT in a real-world population. We conducted a retrospective observational study including patients who underwent CRT-P (pacing)/CRT-D (defibrillator) implantation. Patients were stratified according to HF etiology (ICM vs. NICM). The primary composite endpoint was the occurrence of all-cause mortality and HF hospitalization. Secondary outcomes focused on echocardiographic measures of left ventricular reverse remodeling. Survival analysis was performed using Kaplan-Meier curves and Cox regression models. Of the 95 patients initially screened, 83 were included in the final analysis, of whom 38 (45.8%) had ICM. The mean age was 69.5±10.4 years, and 75.8% were male. Both groups received similar medical therapy. NICM patients demonstrated a significant improvement in reverse remodeling after CRT [left ventricular ejection fraction (LVEF): 32.3±11.5% to 44.0±13.2%, p=0.001); end-diastolic volume (LVEDV): 189.6±74.3 mL to 143.9±48.9 mL, p=0.010] with post-CRT LVEF being higher than in ICM patients (44.0±13.2% vs. 35.5±13.5%, p=0.003). NICM patients were more likely to be super-responders (58.1% vs. 25.0%, p=0.014). No significant differences were observed between groups in the primary composite endpoint (27.3% vs. 42.1%, p=0.171) or overall survival over a mean follow-up of 35 months (log-rank p=0.733). Although ICM patients showed less pronounced reverse remodeling following CRT, long-term clinical outcomes and survival were comparable to those observed in NICM. These findings reinforce the role of CRT as a disease-modifying therapy that prevents disease progression irrespective of HF etiology and support its systematic use in all eligible patients.
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Pereira et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction and left bundle branch block undergoing cardiac resynchronization therapy (CRT) (n=83). Ischemic cardiomyopathy (ICM) undergoing cardiac resynchronization therapy (CRT-P/CRT-D) vs. Non-ischemic cardiomyopathy (NICM) undergoing cardiac resynchronization therapy (CRT-P/CRT-D) was evaluated on Composite of all-cause mortality and heart failure hospitalization over a mean follow-up of 35 months (p=0.171). Ischemic cardiomyopathy patients undergoing CRT had comparable rates of the composite of all-cause mortality and HF hospitalization vs non-ischemic cardiomyopathy (42.1% vs 27.3%, p=0.171).
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