Long-Term Reverse Remodeling With Cardiac Resynchronization Therapy

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

doi:10.1016/j.jacc.2010.01.022

Cited by 80 publications

(71 citation statements)

References 30 publications

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“…Of the 7 identified baseline clinical and echocardiographic covariates that made up the response score in the present study, 4 clinical variables were also previously reported to predict reverse remodeling in patients with more advanced HF symptoms: a nonischemic origin of cardiomyopathy, 15,21,22 female sex, 22,23 QRS width, 2,22,24 and the presence of left bundle-branch block on the baseline ECG. 25,26 In contrast, prior studies did not identify baseline cardiac volumes and a history of HF hospitalization as independent predictors of LV reverse remodeling in patients with advanced HF symptoms.…”

Section: Discussionmentioning

confidence: 71%

“…25,26 In contrast, prior studies did not identify baseline cardiac volumes and a history of HF hospitalization as independent predictors of LV reverse remodeling in patients with advanced HF symptoms. 22 Thus, it is possible that the relationships between the last 3 predictors of reverse remodeling in MADIT-CRT are specific to the study population, or our sample from it, that was made up of patients with less advanced HF symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Response to Cardiac Resynchronization Therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)

et al. 2011

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on behalf of the MADIT-CRT Executive CommitteeBackground-We hypothesized that combined assessment of factors that are associated with favorable reverse remodeling after cardiac resynchronization-defibrillator therapy (CRT-D) can be used to predict clinical response to the device. Methods and Results-The study population comprised 1761 patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT). Best-subset regression analysis was performed to identify factors associated with echocardiographic response (defined as percent reduction in left ventricular end-diastolic volume 1 year after CRT-D implantation) and to create a response score. Cox proportional hazards regression analysis was used to evaluate the CRT-D versus defibrillator-only reduction in the risk of heart failure or death by the response score. Seven factors were identified as associated with echocardiographic response to CRT-D and made up the response score (female sex, nonischemic origin, left bundle-branch block, QRS Ն150 milliseconds, prior hospitalization for heart failure, left ventricular end-diastolic volume Ն125 mL/m 2 , and left atrial volume Ͻ40 mL/m 2 ). Multivariate analysis showed a 13% (PϽ0.001) increase in the clinical benefit of CRT-D per 1-point increment in the response score (range, 0 -14) and a significant direct correlation between risk reduction associated with CRT-D and response score quartiles: Patients in the first quartile did not derive a significant reduction in the risk of heart failure or death with CRT-D (hazard ratioϭ0.87; Pϭ0.52); patients in the second and third quartiles derived 33% (Pϭ0.04) and 36% (Pϭ0.03) risk reductions, respectively; and patients in the upper quartile experienced a 69% (PϽ0.001) risk reduction (P for trendϭ0.005). Conclusion-Combined assessment of factors associated with reverse remodeling can be used for improved selection of patients for cardiac resynchronization therapy. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Predictors of Response to Cardiac Resynchronization Therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)

et al. 2011

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“…We tested the models with the break point set up at the 3rd, 90th, 180th, and 360th day of CRT. 15,23 In a second step, we assessed the timed-dependent correlation between changes in MR and the amount of reverse remodeling during CRT. For this purpose, we again used a linear mixed-effects model approach to correlate VC change from baseline with percentage LVESVi change from baseline, with the time covariate set to 0 if the data were assessed during the first 7 days and to 1 if otherwise.…”

Section: Discussionmentioning

confidence: 99%

“…15 Patients with a major event during these first 3 months (early death or urgent trans-plantation) were excluded. Baseline and every subsequent echocardiogram obtained at our institution during the follow-up of the patient after initiation CRT were systematically reviewed and measured by 2 experienced readers (D.V.…”

Section: Study Population and Study Designmentioning

confidence: 99%

Impact of Mitral Regurgitation on Reverse Remodeling and Outcome in Patients Undergoing Cardiac Resynchronization Therapy

Verhaert

Popović

et al. 2012

Circ: Cardiovascular Imaging

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Background-Mitral regurgitation (MR) is associated with reduced survival in patients with chronic heart failure, but may be improved with cardiac resynchronization therapy (CRT). We sought to evaluate the relationship between serial measurements of functional MR and reverse remodeling and outcomes in patients undergoing CRT. Methods and Results-A total of 266 consecutive patients undergoing 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 (LV) assist device. Temporal changes in MR severity and LV end-systolic volume index (LVESVi) were evaluated by linear mixed-model analysis. CRT led to an immediate sustained decrease in MR (PϽ0.0001), with no significant subsequent change. The amount of MR decrease correlated with a greater decrease in LVESVi late (PՅ0.0001), but not early (Pϭ0.14), after CRT began.Patients with severe MR before CRT experienced a larger LVESVi decrease (Pϭ0.005). Although baseline MR severity was not associated with adverse events (Pϭ0.13), a larger MR decrease (Pϭ0.001) and a smaller residual MR after the initial 6 months of CRT (Pϭ0.03) were predictive of better outcome in a multivariable model. Conclusions-Early reversal of functional MR was associated with reverse cardiac remodeling and improved outcomes.Patients with moderately severe to severe MR before CRT experienced relatively more reverse remodeling than patients with lesser degrees of MR. (Circ Cardiovasc Imaging. 2012;5:21-26.)

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“…20,21 Reverse remodeling with CRT occurs primarily within the first 6 months after implantation and provides strong prognostic benefit in patients with traditional indications. 22 Therefore, the demonstration of reverse remodeling in both MADIT-CRT and REVERSE provides a very strong argument for CRT based on the ability of this intervention to directly improve the biological changes resulting from the pathophysiology of HF. However, reverse remodeling did not occur in all patients despite the intended purpose of restoring synchrony with CRT.…”

Section: Do the Hf Events In The Primary End Point That Were Reduced mentioning

confidence: 99%

Cardiac Resynchronization Therapy in Patients With Class I–II Heart Failure and a Wide QRS

Tang

Francis

2011

Circulation

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Long-Term Reverse Remodeling With Cardiac Resynchronization Therapy

Abstract: 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.

Cited by 80 publications

References 30 publications

Predictors of Response to Cardiac Resynchronization Therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)

Predictors of Response to Cardiac Resynchronization Therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)

Impact of Mitral Regurgitation on Reverse Remodeling and Outcome in Patients Undergoing Cardiac Resynchronization Therapy

Cardiac Resynchronization Therapy in Patients With Class I–II Heart Failure and a Wide QRS

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