The effect of reverse remodeling on long-term survival in mildly symptomatic patients with heart failure receiving cardiac resynchronization therapy: Results of the REVERSE study

• Published in: Heart rhythm Vol. 12; no. 3; pp. 524 - 530
• Main Authors: Gold, Michael R., MD, PhD, FHRS, Daubert, Claude, MD, Abraham, William T., MD, Ghio, Stefano, MD, St. John Sutton, Martin, MD, Hudnall, John Harrison, BS, Cerkvenik, Jeffrey, MS, Linde, Cecilia, MD, PhD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2015; Elsevier
• Subjects: Aged; Cardiac resynchronization therapy; Cardiac Resynchronization Therapy - methods; Cardiac Resynchronization Therapy - mortality; Cardiac Resynchronization Therapy - statistics & numerical data; Cardiology and cardiovascular system; Cardiovascular; Defibrillator; Double-Blind Method; Echocardiography; Engineering Sciences; Female; Follow-Up Studies; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Human health and pathology; Humans; Implantable cardioverter-defibrillator; Life Sciences; Male; Medicin och hälsovetenskap; Middle Aged; Remodeling; Signal and Image processing; Stroke Volume; Survivors - statistics & numerical data; Treatment Outcome; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Remodeling; EF; heart failure; CRT; ejection fraction; cardiac resynchronization therapy; left ventricular end-systolic volume index; LVESVi; CRT-D; LV; left bundle branch block; Remodeling; Implantable cardioverter-defibrillator; cardiac resynchronization therapy with defibrillator; left ventricular end-diastolic volume index; LVEDVi; LBBB; left ventricular; REVERSE; REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction; HF; Defibrillator; Heart failure; Cardiac resynchronization therapy
• ISSN: 1547-5271; 1556-3871; 1556-3871; 1547-5271
• DOI: 10.1016/j.hrthm.2014.11.014

Background Cardiac resynchronization therapy (CRT) reduces mortality, improves functional status, and induces reverse left ventricular remodeling in selected populations with heart failure (HF). The magnitude of reverse remodeling predicts survival with many HF medical therapies. However, there are few studies assessing the effect of remodeling on long-term survival with CRT. Objective The purpose of this study was to assess the effect of CRT-induced reverse remodeling on long-term survival in patients with mildly symptomatic heart failure. Methods The REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction trial was a multicenter, double-blind, randomized trial of CRT in patients with mild HF. Long-term follow-up of 5 years was preplanned. The present analysis was restricted to the 353 patients who were randomized to the CRT ON group with paired echocardiographic studies at baseline and 6 months postimplantation. The left ventricular end-systolic volume index (LVESVi) was measured in the core laboratory and was an independently powered end point of the REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction trial. Results A 68% reduction in mortality was observed in patients with ≥15% decrease in LVESVi compared to the rest of the patients ( P = .0004). Multivariable analysis showed that the change in LVESVi was a strong independent predictor ( P = .0002), with a 14% reduction in mortality for every 10% decrease in LVESVi. Other remodeling parameters such as left ventricular end-diastolic volume index and ejection fraction had a similar association with mortality. Conclusion The change in left ventricular end-systolic volume after 6 months of CRT is a strong independent predictor of long-term survival in mild HF.