1. Cardiac resynchronization induces major structural and functional reverse remodeling in patients with New York Heart Association class I/II heart failure
- Author
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Michael R. Gold, Cecilia Linde, William T. Abraham, Stefano Ghio, Ted Plappert, Martin St. John Sutton, John M. Herre, Christian Hassager, Claude Daubert, Luigi Tavazzi, Laura Scelsi, University of Pennsylvania Medical Center, University of Pennsylvania [Philadelphia], Fondazione IRCCS Policlinico San Matteo [Pavia], Università di Pavia, GVM Hospitals of Care and Research, Service de cardiologie et maladies vasculaires, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, Ohio State University [Columbus] (OSU), Division of cardiology, Medical University of South Carolina [Charleston] (MUSC), Department of Cardiology, Copenhagen University Hospital-Rigshospitalet [Copenhagen], Copenhagen University Hospital, Sentara Norfolk General Hospital, Karolinska Institutet [Stockholm]-Karolinska University Hospital [Stockholm], This study was supported by Medtronic Inc (Minneapolis, Minn) and the Medtronic Bakken Research Center B.V. in Maastricht, Netherlands., REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE) Study Group, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], and CHU Pontchaillou [Rennes]
- Subjects
Male ,MESH: Combined Modality Therapy ,Heart disease ,MESH: Echocardiography, Doppler ,Cardiac Volume ,medicine.medical_treatment ,heart failure ,cardiac resynchronization therapy ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,Doppler echocardiography ,Severity of Illness Index ,ventricular remodeling ,MESH: Stroke Volume ,Electrocardiography ,0302 clinical medicine ,[INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing ,Medicine ,echocardiography ,030212 general & internal medicine ,New York Heart Association Class I ,MESH: Treatment Outcome ,MESH: Aged ,Ejection fraction ,MESH: Middle Aged ,medicine.diagnostic_test ,Cardiac Pacing, Artificial ,MESH: Angiotensin-Converting Enzyme Inhibitors ,MESH: Adrenergic beta-Antagonists ,MESH: Heart Failure, Systolic ,Stroke volume ,Middle Aged ,Combined Modality Therapy ,Echocardiography, Doppler ,Treatment Outcome ,Cardiology ,cardiovascular system ,Female ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Cardiology and Cardiovascular Medicine ,[SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing ,medicine.medical_specialty ,Adrenergic beta-Antagonists ,Cardiac resynchronization therapy ,MESH: Ventricular Remodeling ,MESH: Cardiac Pacing, Artificial ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Physiology (medical) ,Internal medicine ,MESH: Severity of Illness Index ,Humans ,cardiovascular diseases ,Ventricular remodeling ,Aged ,MESH: Humans ,business.industry ,MESH: Angiotensin II Type 1 Receptor Blockers ,MESH: Cardiac Volume ,Stroke Volume ,medicine.disease ,MESH: Male ,MESH: Electrocardiography ,Heart failure ,business ,Angiotensin II Type 1 Receptor Blockers ,MESH: Female ,Heart Failure, Systolic - Abstract
Background— Cardiac resynchronization therapy (CRT) improves LV structure, function, and clinical outcomes in New York Heart Association class III/IV heart failure with prolonged QRS. It is not known whether patients with New York Heart Association class I/II systolic heart failure exhibit left ventricular (LV) reverse remodeling with CRT or whether reverse remodeling is modified by the cause of heart failure. Methods and Results— Six hundred ten patients with New York Heart Association class I/II heart failure, QRS duration ≥120 ms, LV end-diastolic dimension ≥55 mm, and LV ejection fraction ≤40% were randomized to active therapy (CRT on; n=419) or control (CRT off; n=191) for 12 months. Doppler echocardiograms were recorded at baseline, before hospital discharge, and at 6 and 12 months. When CRT was turned on initially, immediate changes occurred in LV volumes and ejection fraction; however, these changes did not correlate with the long-term changes (12 months) in LV end-systolic ( r =0.11, P =0.31) or end-diastolic ( r =0.10, P =0.38) volume indexes or LV ejection fraction ( r =0.07, P =0.72). LV end-diastolic and end-systolic volume indexes decreased in patients with CRT turned on (both P P Conclusions— CRT in patients with New York Heart Association I/II resulted in major structural and functional reverse remodeling at 1 year, with the greatest changes occurring in patients with a nonischemic cause of heart failure. CRT may interrupt the natural disease progression in these patients. Clinical Trial Registration— Clinicaltrials.gov Identifier: NCT00271154.
- Published
- 2009