Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never

Abstract

Introduction: Left ventricular reverse remodeling (LVRR), defined as reduction of end-diastolic and end-systolic dimensions and improvement of ejection fraction, is associated with the prognostic implications of cardiac resynchronization therapy (CRT). The time course of LVRR remains poorly characterized. Nevertheless, it has been suggested that it occurs ≤6 months after CRT. Objective: To characterize the long-term echocardiographic and clinical evolution of patients with LVRR occurring >6 months after CRT and to identify predictors of a delayed LVRR response. Methods: A total of 127 consecutive patients after successful CRT implantation were divided into three groups according to LVRR response: Group A, 19 patients (15%) with LVRR after >6 months (late LVRR); Group B, 58 patients (46%) with LVRR before 6 months (early LVRR); and Group C, 50 patients (39%) without LVRR during follow-up (no LVRR). Results: The late LVRR group was older, more often had ischemic etiology and fewer patients were in NYHA class ≤II. Overall, group A presented LVRR between group B and C. This was also the case with the percentage of clinical response (68.4% vs. 94.8% vs. 38.3%, respectively, p<0.001), and hospital readmissions due to decompensated heart failure (31.6% vs. 12.1% vs. 57.1%, respectively, p<0.001). Ischemic etiology (OR 0.044; p=0.013) and NYHA functional class <III (OR 0.056; p=0.063) were the variables with the highest predictive value for late LVRR. Conclusions: Late LVRR has better clinical and echocardiographic outcomes than no LVRR, although with a suboptimal response compared to the early LVRR population. 2174-2049Document downloaded from http://www.elsevier.pt, day 24/03/2016. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 162A. Viveiros Monteiro et al. PALAVRAS-CHAVE Tempo para a remodelagem inversa do ventrículo esquerdo: mais vale tarde do que nunca ResumoIntrodução: A remodelagem inversa do ventrículo esquerdo (RIVE), definida pela redução das dimensões telediastólicas e telessistólicas e pela melhoria da fração de ejeção, tem sido associada às implicações prognósticas da terapia de ressincronização cardíaca (TRC). A evolução temporal da RIVE permanece um processo pouco caracterizado. No entanto, tem sido sugerido que ocorrerá num período ≤6 meses após TRC. Objetivos: Caracterizar a longo prazo a evolução ecocardiográfica e clínica dos pacientes (P) com evidência de RIVE, num período >6 meses após TRC, e identificar preditores de uma resposta de RIVE tardia. Métodos: Cento e vinte e sete P consecutivos, após implantação bem-sucedida de TRC, foram divididos em três grupos, de acordo com a resposta de RIVE: grupo A, 19P (15%) com RIVE após seis meses (RIVE tardia); grupo B, 58P (46%) com RIVE antes dos seis meses (RIVE precoce) e grupo C, 50P (39%) sem RIVE durante o follow-up (sem RIVE). Resultados: O grupo da RIVE tardia era mais velho, tinha mais etiologia isquémica e menos P em classe NYHA≥III. Globalmente, o grupo A apresentou um gr...

Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with Cardiac Resynchronization Therapy

“…Contrary to the results of this study, a previous study reported no significant difference in the time course of CRT response between nonischemic and ischemic HF 15. Another study indicated that ischemic HF was a predictor of late LV reverse remodeling 16. Since temporal CRT response patterns and their mechanisms remain controversial, more studies need to be conducted.…”

Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril‐Valsartan: A Multicenter Echocardiographic Registry

“…LVRR was defined as a relative reduction of LVESV of at least 10% and an increase of LVEF of at least 10% at follow‐up compared with baseline, according to previous studies conducted in similar cohorts. 13 , 14 , 15 The study cohort was then divided into three groups based on the presence, at 6 month follow‐up, of LVRR and LVEF over/under 35%: early complete response (LVRR and LVEF ≥ 35%; Group 1 ), early incomplete response (LVRR and LVEF < 35%; Group 2 ), and no early response (no LVRR and LVEF < 35%; Group 3 ). LV dimensions and LA volumes were indexed to body surface area obtaining LV mass index and maximum and minimum LA volume index (LAVi), according to the European Association of Cardiovascular Imaging/American Society of Echocardiography (EACVI/ASE) recommendations.…”

“…LV end‐diastolic and end‐systolic volumes (LVEDV and LVESV) and EF, LA volume, and area were assessed from the apical four‐ and two‐chamber views (for LVEF, the biplane Simpson method was used). LVRR was defined as a relative reduction of LVESV of at least 10% and an increase of LVEF of at least 10% at follow‐up compared with baseline, according to previous studies conducted in similar cohorts 13–15 . The study cohort was then divided into three groups based on the presence, at 6 month follow‐up, of LVRR and LVEF over/under 35%: early complete response (LVRR and LVEF ≥ 35%; Group 1 ), early incomplete response (LVRR and LVEF < 35%; Group 2 ), and no early response (no LVRR and LVEF < 35%; Group 3 ).…”

Resynchronization Therapy for Chronic Heart Failure: Diagnostic and Therapeutic Approaches

“…Третий электрод предназначен для стимуляции ЛЖ. В большинстве случаев используется трансвенозный доступ для проведения левожелудочкового электрода, посредством которого электрод проводится через коронарный синус (КС) в венозную систему сердца и располагается в одной из ее ветвей на заднебоковой стенке ЛЖ; обычно это латеральная вена сердца [46][47][48].…”