Abstract 1892: The Magnitude of Reverse Remodeling Irrespective of The Etiology Predicts Outcome of Heart Failure Patients Treated With Cardiac Resynchronization Therapy.
Introduction: We assessed the effect of CRT-induced reverse remodeling on mortality during a long-term follow-up in an observational study that included consecutive CRT patients.
Methods: A registry was used to examine all patients who underwent CRT between September 1998 and December 2004. Patients were divided into two groups based on the type of cardiomyopathy (ischemic (CAD) and non ischemic (NO CAD)) and then stratified based on the degree of LV remodeling. Kaplan-Meier survival estimate were then performed according to
CAD etiology, and
LVEF response stratified by the median increment of LVEF response (MDLVEF) and by the upper tertile (TDLVEF) of the increment of LVEF response after CRT.
Results: A total of 325 patients (136 NOCAD and 189 CAD) were analyzed. The mean duration of follow-up was 3.9 ± 1.6 years. The NO CAD group had a statistically significant larger EF increase of 10.36 ± 14.02 from baseline when compared to the CAD group showing an average increase of 5.49 ± 10.43 (P=0.0005). 134 pts had an EF increase ≥ 6 points (65 CAD and 69 NOCAD) (p = 0.004). The survival and event-free survival was similar between CAD and no CAD patients (p = 0.059 and p = 0.068 respectively) when EF increased > 6 points.
Conclusion: Reverse remodeling measured by LVEF after 3 months is a good predictor of long term outcome. Both ischemic and non-ischemic patients have a poor outcome when no reverse remodeling occurs, but patients who have an increase in their EF > 6 points have an excellent event-free survival approaching 80% at 5 years follow-up.