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(Circulation. 2009;120:1858-1865.)
© 2009 American Heart Association, Inc.

Heart Failure

Cardiac Resynchronization Induces Major Structural and Functional Reverse Remodeling in Patients With New York Heart Association Class I/II Heart Failure

Martin St. John Sutton, MB, FRCP; Stefano Ghio, MD; Ted Plappert, CVT; Luigi Tavazzi, MD, FESC; Laura Scelsi, MD; Claude Daubert, MD; William T. Abraham, MD; Michael R. Gold, MD, PhD; Christian Hassager, MD, PhD; John M. Herre, MD; Cecilia Linde, MD, PhD, on Behalf of the REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE) Study Group

From the University of Pennsylvania Medical Center (M.S.J.S., T.P.), Philadelphia, Pa; Policlinico San Matteo (S.G., L.S.), Pavia, Italy; GVM Hospitals of Care and Research (L.T.), Cotignola, Italy; Département de Cardiologie (C.D.), Centre Hospitalier Universitaire, Rennes, France; Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute (W.T.A.), The Ohio State University, Columbus, Ohio; Division of Cardiology (M.R.G.), Medical University of South Carolina, Charleston, SC; Department of Cardiology (C.H.), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Sentara Norfolk General Hospital (J.M.H.), Norfolk, Va; and Department of Cardiology (C.L.), Karolinska University Hospital, Stockholm, Sweden.

Correspondence to Martin St. John Sutton, MB, FRCP, University of Pennsylvania Medical Center, 3400 Spruce St, 9018 Gates Pavilion, Philadelphia, PA 19104. E-mail suttonm{at}mail.med.upenn.edu

Received September 8, 2008; accepted August 11, 2009.

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<0.001 compared with CRT off), whereas LV ejection fraction in CRT-on patients increased (P<0.0001 compared with CRT off) from baseline through 12 months. LV mass, mitral regurgitation, and LV diastolic function did not change in either group by 12 months; however, there was a 3-fold greater reduction in LV end-diastolic and end-systolic volume indexes and a 3-fold greater increase in LV ejection fraction in patients with nonischemic causes of heart failure.

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.

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CLINICAL PERSPECTIVE

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				G. S. Francis and W.H. Wilson Tang Early Cardiac Resynchronization Therapy and Reverse Remodeling in Patients With Mild Heart Failure: Is It Time? Circulation, November 10, 2009; 120(19): 1845 - 1846. [Full Text] [PDF]