Background
Cardiac resynchronization therapy (CRT) response stratified by left ventricular (LV)
remodeling revealed differing mortality profiles for distinct patient cohorts. Measuring
functional end points, as well as mortality, may better assess CRT efficacy and inform
patient management. However, the association between LV remodeling and functional
outcomes after CRT is not well understood.
Objective
The purpose of this study was to evaluate long-term CRT outcomes by extent of LV remodeling.
Methods
REsynchronization reVErses Remodeling in Systolic Left vEntricular dysfunction (ClinicalTrials.gov identifier NCT00271154) was a prospective, double-blind, randomized trial of CRT. Subjects were classified
on the basis of LV end-systolic volume (LVESV) change from baseline to 6 months post-CRT:
worsened (increase), stabilized (0%–≤15% reduction), responder (>15%–<30% reduction),
and super-responder (≥30% reduction). Subjects were evaluated annually for 5 years.
Results
The analyses included 353 subjects randomized to CRT-ON arm. All-cause mortality was
higher in the worsened group than in the other 3 response groups (29.8% vs 8.0%; P < .0001), with no difference in survival among those groups (P = .87). A significant interaction between the LVESV group and time was observed for
health status and quality of life (P = .02 for both). The interaction was not significant for 6-minute hall walk (P = .79); however, super-responders had increased walk distance compared with the other
3 response groups (P = .03).
Conclusion
Preventing further increase in LVESV with CRT was associated with reduced mortality,
whereas functional measure improvement was associated with LV remodeling magnitude.
These results support the consideration of functional and mortality end points to
assess CRT efficacy and provide further evidence that the dichotomous “responder and
nonresponder” classification should be modified.
Keywords
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Article info
Publication history
Published online: November 25, 2022
Footnotes
Funding Sources: The REVERSE trial was supported by Medtronic.
Disclosures: Drs Gold, Linde, and Daubert have served as consultants to and received research grants from Medtronic. Dr Gold has served as a consultant to and received research grants from Boston Scientific. Dr Rickard has received a research grant from Abbott and has been a consultant for Medtronic. Dr Daubert has received research grants, speaker honoraria, and consulting fees from Medtronic and St. Jude Medical. Dr Linde has received honoraria payments from Medtronic, Abbott, and Impulse Dynamics and has been supported by grants from the Swedish Heart Lung Foundation and Stockholm City Council. Mr Cerkvenik is an employee and shareholder of Medtronic.
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