Heart failure
Reverse of Left Ventricular Volumetric and Structural Remodeling in Heart Failure Patients Treated With Cardiac Resynchronization Therapy

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Patients with heart failure and mechanical dyssynchrony suffer a progressive increase in left ventricular (LV) mass and asymmetrical regional hypertrophy with eventual poor prognosis. The present study sought to investigate whether cardiac resynchronization therapy (CRT) could reverse these abnormalities. The study included 66 consecutive heart failure patients who received CRT. All patients underwent serial evaluation before, 3 months after, and 12 months after CRT. At 12 months after CRT, 50 patients (76%) were echocardiographic volumetric responders, defined as a >15% reduction in LV end-systolic volume. LV end-systolic volume was decreased from 214 ± 97 ml to 179 ± 88 ml at 3 months and was further decreased to 158 ± 86 ml at 12 months after CRT (all p <0.01). LV ejection fraction was improved from 18% ± 4% to 28% ± 7% (p <0.001) at 3 months without further change at 12 months after CRT. LV mass was reduced from 242 ± 52 g to 222 ± 45 g at 3 months and was further reduced to 206 ± 50 g at 12 months after CRT (all p <0.01). Improvement of LV geometry was seen as improvements of the end-diastolic (1.64 ± 0.14 vs 1.77 ± 0.17, p <0.001) and the end-systolic (1.63 ± 0.14 vs 1.99 ± 0.22, p <0.001) sphericity indexes, respectively, at 3 months, without further significant changes at 12 months after CRT. Volumetric responders had a reduction in LV mass from 240 ± 50 to 210 ± 38 at 3 months, and LV mass was further reduced to 186 ± 37 g at 12 months after CRT (all p <0.01). In contrast, nonresponders had a progressive increase in LV mass from 248 ± 59 g to 258 ± 54 g at 3 months, and LV mass was further increased to 269 ± 60 g at 12 months after CRT (all p <0.05). Likewise, only in volumetric responders, regression of the asymmetric hypertrophy of the lateral wall was noted. In conclusion, CRT results in not only volumetric improvement but also in true reverse LV structural remodeling, evidenced by progressive reduction in LV mass and restoration of regional wall symmetry.

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

References (29)

  • A. Auricchio et al.

    Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failureThe Pacing Therapies for Congestive Heart Failure Study Group. The Guidant Congestive Heart Failure Research Group

    Circulation

    (1999)
  • D.A. Kass et al.

    Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay

    Circulation

    (1999)
  • C.M. Yu et al.

    Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy

    Circulation

    (2005)
  • Q. Zhang et al.

    Differential change in left ventricular mass and regional wall thickness after cardiac resynchronization therapy for heart failure

    Eur Heart J

    (2006)
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