This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Ypenburg, C. Articles by Bax, J. J. Search for Related Content PubMed Articles by Ypenburg, C. Articles by Bax, J. J. Related Collections Related Article

CLINICAL RESEARCH: CARDIAC RESYNCHRONIZATION THERAPY

Long-Term Prognosis After Cardiac Resynchronization Therapy Is Related to the Extent of Left Ventricular Reverse Remodeling at Midterm Follow-Up

Claudia Ypenburg, MD^_*, Rutger J. van Bommel, MD^_*, C. Jan Willem Borleffs, MD^_*, Gabe B. Bleeker, MD, PhD^_*, Eric Boersma, PhD, Martin J. Schalij, MD, PhD^_* and Jeroen J. Bax, MD, PhD^_*,_*

^_* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Epidemiology and Statistics, Erasmus University, Rotterdam, the Netherlands

Manuscript received August 11, 2008; revised manuscript received October 15, 2008, accepted October 19, 2008.

^_* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands (Email: j.j.bax{at}lumc.nl).

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 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.

Key Words: cardiac resynchronization therapy • reverse remodeling • echocardiography • heart failure • prognosis

Abbreviations and Acronyms   CRT = cardiac resynchronization therapy   LBBB = left bundle branch block   LV = left ventricle/ventricular   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   LVESV = left ventricular end-systolic volume   NYHA = New York Heart Association

Related Article

Inside This Issue
J. Am. Coll. Cardiol. 2009 53: A26. [Full Text] [PDF]

This article has been cited by other articles:

				F. Cabrera-Bueno, M. J. Molina-Mora, J. Alzueta, J. Pena-Hernandez, M. Jimenez-Navarro, J. Fernandez-Pastor, A. Barrera, and E. de Teresa Persistence of secondary mitral regurgitation and response to cardiac resynchronization therapy Eur J Echocardiogr, November 24, 2009; (2009) jep184v1. [Abstract] [Full Text] [PDF]

				B. Sassone, L. Gabrieli, S. Sacca, G. Boggian, A. Fusco, C. Pratola, M. L. Bacchi-Reggiani, L. Padeletti, and S. S. Barold Value of right ventricular-left ventricular interlead electrical delay to predict reverse remodelling in cardiac resynchronization therapy: the INTER-V pilot study Europace, November 6, 2009; (2009) eup347v1. [Abstract] [Full Text] [PDF]

				P. W.X. Foley, F. Leyva, and M. P. Frenneaux What is treatment success in cardiac resynchronization therapy? Europace, November 1, 2009; 11(suppl_5): v58 - v65. [Abstract] [Full Text] [PDF]

				R. J. van Bommel, J. J. Bax, W. T. Abraham, E. S. Chung, L. A. Pires, L. Tavazzi, P. J. Zimetbaum, B. Gerritse, N. Kristiansen, and S. Ghio Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis Eur. Heart J., October 2, 2009; 30(20): 2470 - 2477. [Abstract] [Full Text] [PDF]

				L. F. Tops, M. J. Schalij, and J. J. Bax The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 764 - 776. [Abstract] [Full Text] [PDF]

				M. G. J. Gademan, R. J. van Bommel, C. J. W. Borleffs, S. Man, J. C. W. Haest, M. J. Schalij, E. E. van der Wall, J. J. Bax, and C. A. Swenne Biventricular pacing-induced acute response in baroreflex sensitivity has predictive value for midterm response to cardiac resynchronization therapy Am J Physiol Heart Circ Physiol, July 1, 2009; 297(1): H233 - H237. [Abstract] [Full Text] [PDF]

				J. E. Sanderson Echocardiography for cardiac resynchronization therapy selection: fatally flawed or misjudged? J. Am. Coll. Cardiol., May 26, 2009; 53(21): 1960 - 1964. [Abstract] [Full Text] [PDF]