The effect of reverse remodeling on long-term survival in mildly symptomatic patients with heart failure receiving cardiac resynchronization therapy: Results of the REVERSE study

Michael R. Gold (1) , Claude Daubert (2, 3) , William T. Abraham (4) , Stefano Ghio (5) , Martin St. John Sutton (6) , John Harrison Hudnall (7) , Jeffrey Cerkvenik (7) , Cecilia Linde (8)

1 MUSC - Medical University of South Carolina [Charleston]
2 Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes]
3 CIC - Centre d'Investigation Clinique [Rennes]
4 OSU - Ohio State University [Columbus]
5 Fondazione IRCCS Policlinico San Matteo [Pavia]
6 University of Pennsylvania Medical Center
7 Medtronic Inc
8 Department of Cardiology

Background Cardiac resynchronization therapy (CRT) reduces mortality, improves functional status, and induces reverse left ventricular remodeling in selected populations with heart failure (HF). The magnitude of reverse remodeling predicts survival with many HF medical therapies. However, there are few studies assessing the effect of remodeling on long-term survival with CRT. Objective The purpose of this study was to assess the effect of CRT-induced reverse remodeling on long-term survival in patients with mildly symptomatic heart failure. Methods The REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction trial was a multicenter, double-blind, randomized trial of CRT in patients with mild HF. Long-term follow-up of 5 years was preplanned. The present analysis was restricted to the 353 patients who were randomized to the CRT ON group with paired echocardiographic studies at baseline and 6 months postimplantation. The left ventricular end-systolic volume index (LVESVi) was measured in the core laboratory and was an independently powered end point of the REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction trial. Results A 68% reduction in mortality was observed in patients with ≥15% decrease in LVESVi compared to the rest of the patients (P = .0004). Multivariable analysis showed that the change in LVESVi was a strong independent predictor (P = .0002), with a 14% reduction in mortality for every 10% decrease in LVESVi. Other remodeling parameters such as left ventricular end-diastolic volume index and ejection fraction had a similar association with mortality. Conclusion The change in left ventricular end-systolic volume after 6 months of CRT is a strong independent predictor of long-term survival in mild HF

Keywords: Heart failure; Implantable cardioverter-defibrillator; Defibrillator; Cardiac resynchronization therapy; Remodeling

Domains: Engineering Sciences [physics]; Signal and Image processing; Life Sciences [q-bio]; Human health and pathology; Cardiology and cardiovascular system

Michael R. Gold, Claude Daubert, William T. Abraham, Stefano Ghio, Martin St. John Sutton, et al.. The effect of reverse remodeling on long-term survival in mildly symptomatic patients with heart failure receiving cardiac resynchronization therapy: Results of the REVERSE study. Heart Rhythm, 2015, 12 (3), pp.524--530. ⟨10.1016/j.hrthm.2014.11.014⟩. ⟨hal-01220636⟩