Long-Term Reverse Remodeling With Cardiac Resynchronization Therapy. Results of Extended Echocardiographic Follow-Up

David Verhaert, Richard A. Grimm, Chirapa Puntawangkoon, Kathy Wolski, Sabe De, Bruce L. Wilkoff, Randall C. Starling, W. H Wilson Tang, James D. Thomas, Zoran B. Popović*

*Corresponding author for this work

Research output: Contribution to journalArticle

57 Scopus citations

Abstract

Objectives: The purpose of this study was to describe the long-term course of left ventricular remodeling induced by cardiac resynchronization therapy (CRT), adjusting for the confounding effect of patient loss due to disease. Background: Reverse remodeling has been identified as the primary mechanism of improved symptoms and outcome in heart failure patients. Methods: A total of 313 consecutive patients who underwent CRT with available baseline echocardiograms and subsequent clinical and echocardiographic follow-up were included in the analysis. Long-term follow-up included all-cause mortality, heart transplantation, and implantation of a left ventricular assist device. Longitudinal data analysis of left ventricular end-systolic volume index (LVESVi) was performed to adjust for the confounding effect of patient loss during follow-up. Results: Patients with uneventful survival had a lower baseline LVESVi (Δ = 8.6 ml/m2, SE = 4.6 ml/m2, p < 0.0001) and a decreased LVESVi by -0.11 ml/m2/day during first 6 months, whereas the LVESVi remained unchanged in patients with adverse events (p < 0.0001). Beyond 6 months, the LVESVi remained unchanged in patients with uneventful survival, whereas the LVESVi continued to increase in those with adverse events at a rate of 0.01 ml/m2/day (p < 0.0001). Predictors of reverse remodeling were nonischemic etiology, female sex, and a wider QRS duration (p < 0.0001, p = 0.014, and p = 0.001, respectively). In the majority of patients, 6 months indicates a break point after which reverse remodeling becomes significantly less pronounced. Conclusions: CRT patients with uneventful survival show a significant decrease in the LVSVi at 6 months and generally maintain this response in the long term. Those with adverse outcomes are characterized by left ventricular dilation despite CRT.

Original languageEnglish (US)
Pages (from-to)1788-1795
Number of pages8
JournalJournal of the American College of Cardiology
Volume55
Issue number17
DOIs
StatePublished - Apr 27 2010

Keywords

  • cardiac resynchronization therapy
  • heart failure
  • remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Verhaert, D., Grimm, R. A., Puntawangkoon, C., Wolski, K., De, S., Wilkoff, B. L., Starling, R. C., Tang, W. H. W., Thomas, J. D., & Popović, Z. B. (2010). Long-Term Reverse Remodeling With Cardiac Resynchronization Therapy. Results of Extended Echocardiographic Follow-Up. Journal of the American College of Cardiology, 55(17), 1788-1795. https://doi.org/10.1016/j.jacc.2010.01.022