Author + information
- Michael Robert Gold,
- Jean-Claude Daubert,
- William Abraham,
- Stefano Ghio,
- Martin St. John Sutton,
- J Harrison Hudnall,
- Jeffrey Cerkvenik and
- Cecilia Linde
Cardiac Resynchronization Therapy (CRT) is effective at improving functional status, heart failure (HF) symptoms and reducing mortality. Improvement in cardiac function is a marker of CRT response, but the relationship of reverse remodeling to long-term mortality is not well-understood.
The REVERSE study randomized 419 patients with NYHA l/ll HF to CRT ON with a prospectively planned long-term follow-up phase. Of these patients, 353 had paired left ventricular end systolic volume index (LVESVi) measurements at baseline and 6 months post-implant. Subjects were grouped by LVESVi change to examine mortality rates. Additionally, LVESVi change was treated as a continuous variable in Cox proportional hazards models, first independently, then with baseline covariates.
Patients in whom LVESVi decreased > 15% at 6 months had a 6.9% mortality rate at four years. This was significantly lower than the 16.4% mortality rate among patients with < 15% reduction. The change in LVESVi was a significant predictor of mortality (p<0.0001) as a 10% decrease in LVESVi corresponds to a 13% decrease in mortality risk. Multi-variable analysis showed that less reduction in LVESVi, male gender, higher baseline LVESVi, and shorter QRS duration were independent predictors of mortality (table).
LVESVi change with CRT is a strong predictor of long-term survival in mild heart failure. Very low mortality rates (1-2% per year) were observed in the presence of large reductions of LVESVi.
Oral Contributions West, Room 2006
Saturday, March 09, 2013, 8:15 a.m.-8:30 a.m.
Session Title: Resynchronization Therapy and Right Ventricular Function
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 906-4
- 2013 American College of Cardiology Foundation