Long-term prognosis after cardiac resynchronization therapy is related to the extent of left ventricular reverse remodeling at midterm follow-up.

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.

[1]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[2]  J. Daubert,et al.  Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure. , 1999, The American journal of cardiology.

[3]  S. Yusuf,et al.  Effects of the Angiotensin Converting Enzyme Inhibitor Enalapril on the Long‐term Progression of Left Ventricular Dilatation in Patients With Asymptomatic Systolic Dysfunction , 1993, Circulation.

[4]  D. Kass,et al.  Cardiac Resynchronization Therapy , 2007, Mayo Clinic Cardiology.

[5]  J. Cohn,et al.  Validity of the Minnesota Living with Heart Failure questionnaire as a measure of therapeutic response to enalapril or placebo. , 1993, The American journal of cardiology.

[6]  Jeroen J. Bax,et al.  Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. , 2004, Journal of the American College of Cardiology.

[7]  Chu-Pak Lau,et al.  Tissue Doppler Echocardiographic Evidence of Reverse Remodeling and Improved Synchronicity by Simultaneously Delaying Regional Contraction After Biventricular Pacing Therapy in Heart Failure , 2002, Circulation.

[8]  D. Delurgio,et al.  Cardiac resynchronization in chronic heart failure. , 2002, The New England journal of medicine.

[9]  J. Blanc,et al.  Cardiac resynchronization therapy: "nonresponders" and "hyperresponders". , 2008, Heart rhythm.

[10]  D. DeMets,et al.  Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. , 2004, The New England journal of medicine.

[11]  Stefan Sack,et al.  Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. , 2002, Journal of the American College of Cardiology.

[12]  J. Blanc,et al.  Evaluation of left bundle branch block as a reversible cause of non-ischaemic dilated cardiomyopathy with severe heart failure. A new concept of left ventricular dyssynchrony-induced cardiomyopathy. , 2005, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[13]  S. Yusuf,et al.  Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dysfunction in patients with heart failure. SOLVD Investigators. , 1992, Circulation.

[14]  S. Yusuf,et al.  Effects of the Angiotensin Converting Enzyme Inhibitor Enalapril on the Long‐term: Progression of Left Ventricular Dysfunction in Patients With Heart Failure , 1992, Circulation.

[15]  M. Kronenberg,et al.  Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (Studies of Left Ventricular Dysfunction) Investigators. , 1993, Circulation.

[16]  P. Hildebrandt,et al.  Antiremodeling effects on the left ventricle during beta-blockade with metoprolol in the treatment of chronic heart failure. , 2000, Journal of the American College of Cardiology.

[17]  Milton Packer,et al.  Cardiac resynchronization in chronic heart failure. , 2002, The New England journal of medicine.

[18]  J. Daubert,et al.  Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. , 2001, The New England journal of medicine.

[19]  B. Pieske Can brain natriuretic peptide be used to diagnose and manage patients with diastolic heart failure? , 2006, Nature Clinical Practice Cardiovascular Medicine.

[20]  L. Fisher,et al.  Surrogate end points in heart failure. , 2002, Journal of the American College of Cardiology.

[21]  R. Doughty,et al.  Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease , 1997 .

[22]  R. Canby,et al.  Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. , 2003, JAMA.

[23]  Australia. Randomised, placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease , 1997, The Lancet.

[24]  P A Poole-Wilson,et al.  Six minute walking test for assessing exercise capacity in chronic heart failure. , 1986, British medical journal.

[25]  David L Hayes,et al.  Sustained Reverse Left Ventricular Structural Remodeling With Cardiac Resynchronization at One Year Is a Function of Etiology: Quantitative Doppler Echocardiographic Evidence From the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) , 2006, Circulation.

[26]  Lluís Mont,et al.  Predictors of lack of response to resynchronization therapy. , 2005, The American journal of cardiology.

[27]  J. Daubert,et al.  The effect of cardiac resynchronization on morbidity and mortality in heart failure. , 2005, The New England journal of medicine.

[28]  James Young,et al.  Patient Selection for Cardiac Resynchronization Therapy: From the Council on Clinical Cardiology Subcommittee on Electrocardiography and Arrhythmias and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in Collaboration With the Heart Rhythm Society , 2005, Circulation.

[29]  J. Conti,et al.  Ventricular Reverse Remodeling and 6-Month Outcomes in Patients Receiving Cardiac Resynchronization Therapy: Analysis of the MIRACLE Study , 2005, Journal of Interventional Cardiac Electrophysiology.

[30]  Jeroen J. Bax,et al.  Left Ventricular Reverse Remodeling but Not Clinical Improvement Predicts Long-Term Survival After Cardiac Resynchronization Therapy , 2005, Circulation.