The magnitude of reverse remodelling irrespective of aetiology predicts outcome of heart failure patients treated with cardiac resynchronization therapy

Luigi Di Biase, Angelo Auricchio, Antonio Sorgente, Kenneth Civello, Catherine Klersy, Francesco Faletra, Lucie Riedlbauchova, Dimpi Patel, Mauricio Arruda, Robert A. Schweikert, David O. Martin, Walid I. Saliba, Tiziano Moccetti, Bruce L. Wilkoff, Andrea Natale

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42 Scopus citations

Abstract

Aims: We assessed the relationship between cardiac resynchronization therapy (CRT)-induced reverse remodelling and mortality during a long-term follow-up in a prospective observational study. Methods and results: We analyzed data from a prospective registry including 398 consecutive patients who underwent CRT between September 1998 and September 2007. Left ventricular ejection fraction (LVEF) was assessed before CRT and in the period between 3 and 6 months following implant. All-cause mortality, urgent transplantation and implantation of left ventricular assist device were all considered relevant events. A total of 398 (179 non-ischaemic and 219 ischaemic) patients were analysed. Overall, the increase of LVEF was statistically significant and was computed with 7.0 points (95% CI 5.8-8.3, P < 0.001). Non-ischaemic patients had a larger increase [9.2 points (95% CI 7.0-11.1), P < 0.001] of their LVEF from baseline, when compared with the ischaemic group. The median duration of follow-up was 4.4 years. The cumulative incidence of all events at the end of the 96 months period of follow-up was 55% and it was 34% (95% CI 29-40) at 5 years. At the multivariable analysis of the event-free survival, aetiology lost its predictive value (HR 0.92, P = 0.47), while a change in LVEF ≥6 points still significantly decreased the risk of event during the follow-up (HR 0.30, P = 0.001). Conclusion: Reverse remodelling measured by LVEF after 3 months is a good predictor of long-term outcome. Patients with an increase in LVEF ≥6 points have an excellent event-free survival approaching 66% at 5 years of follow-up.

Original languageEnglish (US)
Pages (from-to)2497-2505
Number of pages9
JournalEuropean heart journal
Volume29
Issue number20
DOIs
StatePublished - Oct 1 2008
Externally publishedYes

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Keywords

  • Cardiac resynchronization therapy
  • Ejection fraction
  • Heart failure
  • Ischaemic and non-ischaemic aetiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Di Biase, L., Auricchio, A., Sorgente, A., Civello, K., Klersy, C., Faletra, F., Riedlbauchova, L., Patel, D., Arruda, M., Schweikert, R. A., Martin, D. O., Saliba, W. I., Moccetti, T., Wilkoff, B. L., & Natale, A. (2008). The magnitude of reverse remodelling irrespective of aetiology predicts outcome of heart failure patients treated with cardiac resynchronization therapy. European heart journal, 29(20), 2497-2505. https://doi.org/10.1093/eurheartj/ehn221