Heart failureReverse of Left Ventricular Volumetric and Structural Remodeling in Heart Failure Patients Treated With Cardiac Resynchronization Therapy
Section snippets
Study population
The study enrollment criteria were (1) New York Heart Association functional class ≥III despite optimal drug therapy, (2) impaired LV ejection fraction <35%, and (3) wide QRS complex >120 ms. These CRT indications comply with current guidelines.10 Patients with acute coronary syndrome or coronary revascularization within 6 months before CRT were excluded. An informed consent was obtained from all patients, and the institutional review board approved the study.
Out of the 74 patients initially
Baseline demographics
Mean age of the 66 patients was 59 ± 11 years, and 45 were men (68%). Sixty-three patients (95%) were in New York Heart Association class III; 3 patients were in New York Heart Association class IV. At baseline, β blockers were used in 76% of patients, angiotensin converting-enzyme inhibitors in 92%, diuretics in 95%, amiodarone in 33%, and digitalis in 32%. There were no significant changes in the number or dosage of anti-HF medications after CRT. All other pertinent baseline clinical and
Discussion
In agreement with the major CRT trials,1 most patients in this study benefited from CRT implantation. At 3 months after CRT, reverse LV volumetric remodeling or, more precisely, LV unloading had taken place in 41% of patients, evidenced by reductions in LV volumes with subsequent improvement in LV ejection fraction. At 12 months after CRT, signs of reverse LV volumetric remodeling became more pronounced, and a new and significant proportion of 35% of patients became volumetric responders. This
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