TY - JOUR
T1 - Long-term impact of cardiac resynchronization therapy in mild heart failure
T2 - 5-year results from the resynchronization reverses remodeling in systolic left ventricular dysfunction (REVERSE) study
AU - Linde, Cecilia
AU - Gold, Michael R.
AU - Abraham, William T.
AU - St John Sutton, Martin
AU - Ghio, Stefano
AU - Cerkvenik, Jeff
AU - Daubert, Claude
PY - 2013/9/7
Y1 - 2013/9/7
N2 - BackgroundThe benefit of cardiac resynchronization therapy (CRT) among patients with mild heart failure (HF), reduced left ventricular (LV) function and wide QRS is well established. We studied the long-term stability of CRT.MethodsREVERSE was a randomized, double-blind study on CRT in NYHA Class I and II HF patients with QRS ≥120 ms and left ventricular ejection fraction (LVEF) ≤40%. After the randomized phase, all were programmed to CRT ON and prospectively followed through 5 years for functional capacity, echocardiography, HF hospitalizations, mortality, and adverse events. We report the results of the 419 patients initially assigned to CRT ON.FindingsThe mean follow-up time was 54.8 ± 13.0 months. After 2 years, the functional and LV remodelling improvements were maximal. The 6-min hall walk increased by 18.8 ± 102.3 m and the Minnesota and Kansas City scores improved by 8.2 ± 17.8 and 8.2 ± 17.2 units, respectively. The mean decrease in left ventricular end-systolic volume index and left ventricular end-diastolic volume index was 23.5 ± 34.1 mL/m2 (P <0.0001) and 25.4 ± 37.0 mL/m2 (P <0.0001) and the mean increase in LVEF 6.0 ± 10.8% (P <0.0001) with sustained improvement thereafter. The annualized and 5-year mortality was 2.9 and 13.5% and the annualized and 5-year rate of death or first HF hospitalization 6.4, and 28.1%. The 5-year LV lead-related complication rate was 12.5%.ConclusionIn patients with mild HF, CRT produced reverse LV remodelling accompanied by very low mortality and need for heart failure hospitalization. These effects were sustained over 5 years. Cardiac resynchronization therapy in addition to optimal medical therapy produces long-standing clinical benefits in mild heart failure.Clinical Trial RegistrationClinicaltrials.gov identifier NCT00271154.
AB - BackgroundThe benefit of cardiac resynchronization therapy (CRT) among patients with mild heart failure (HF), reduced left ventricular (LV) function and wide QRS is well established. We studied the long-term stability of CRT.MethodsREVERSE was a randomized, double-blind study on CRT in NYHA Class I and II HF patients with QRS ≥120 ms and left ventricular ejection fraction (LVEF) ≤40%. After the randomized phase, all were programmed to CRT ON and prospectively followed through 5 years for functional capacity, echocardiography, HF hospitalizations, mortality, and adverse events. We report the results of the 419 patients initially assigned to CRT ON.FindingsThe mean follow-up time was 54.8 ± 13.0 months. After 2 years, the functional and LV remodelling improvements were maximal. The 6-min hall walk increased by 18.8 ± 102.3 m and the Minnesota and Kansas City scores improved by 8.2 ± 17.8 and 8.2 ± 17.2 units, respectively. The mean decrease in left ventricular end-systolic volume index and left ventricular end-diastolic volume index was 23.5 ± 34.1 mL/m2 (P <0.0001) and 25.4 ± 37.0 mL/m2 (P <0.0001) and the mean increase in LVEF 6.0 ± 10.8% (P <0.0001) with sustained improvement thereafter. The annualized and 5-year mortality was 2.9 and 13.5% and the annualized and 5-year rate of death or first HF hospitalization 6.4, and 28.1%. The 5-year LV lead-related complication rate was 12.5%.ConclusionIn patients with mild HF, CRT produced reverse LV remodelling accompanied by very low mortality and need for heart failure hospitalization. These effects were sustained over 5 years. Cardiac resynchronization therapy in addition to optimal medical therapy produces long-standing clinical benefits in mild heart failure.Clinical Trial RegistrationClinicaltrials.gov identifier NCT00271154.
KW - Cardiac resynchronization therapy
KW - Electrical dyssynchrony
KW - Heart failure
KW - Mortality
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U2 - 10.1093/eurheartj/eht160
DO - 10.1093/eurheartj/eht160
M3 - Article
C2 - 23641006
AN - SCOPUS:84883746913
VL - 34
SP - 2592
EP - 2599
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 33
ER -