The Impact of Reverse Remodeling on Long Term Survival in Mildly Symptomatic Heart Failure Patients Receiving Cardiac Resynchronization Therapy: Results from the REVERSE study.

Heart rhythm : the official journal of the Heart Rhythm Society

PubMedID: 25460860

Gold MR, Daubert C, Abraham WT, Ghio S, John Sutton MS, Hudnall JH, Cerkvenik J, Linde C. The Impact of Reverse Remodeling on Long Term Survival in Mildly Symptomatic Heart Failure Patients Receiving Cardiac Resynchronization Therapy: Results from the REVERSE study. Heart Rhythm. 2014;.
BACKGROUND
Cardiac resynchronization therapy (CRT) decreases mortality, improves functional status and induces reverse left ventricular (LV) remodeling in selected populations with heart failure (HF). The magnitude of reverse remodeling predicts survival with many HF medical therapies. However, there are little data assessing the impact of remodeling on long term survival with CRT.

OBJECTIVE
To assess the impact of CRT induced reverse remodeling on long term survival in mild HF.

METHODS
REVERSE was a multi-center, double-blind, randomized trial of CRT among patients with mild HF. Long-term follow-up for 5 years was pre-planned. The present analysis was confined to the 353 patients who were randomized to CRT ON with paired echocardiographic studies at baseline and 6 months post-implant. Left ventricular end systolic volume index (LVESVi) was measured by a core laboratory and was an independently powered endpoint of REVERSE.

RESULTS
A 68% reduction in mortality was observed among patients with =15% decrease in LVESVi compared to the rest of the patients (p=0.0004). Multivariable analysis showed that the change in LVESVi was a strong independent predictor (p=0.0002) with a 14% reduction of mortality for every 10% decrease of LVESVi. Other remodeling parameters, including left ventricular end diastolic volume index and ejection fraction showed a similar relationship with mortality.

CONCLUSION
Change in left ventricular end systolic volume over 6 months of CRT is a strong independent predictor of long term survival in mild HF.

CLINICAL TRIAL REGISTRATION: URL
http://clinicaltrials.gov/ct2/show/NCT00271154. Unique identifier: NCT00271154.