Abstract 1894: Remission of Left Ventricular Systolic Dysfunction and of Heart Failure Symptoms After Cardiac Resynchronization Therapy: Incidence and Clinical Predictors
Aim: To determine whether CRT may induce a HF remission phase (recovery to NYHA I-II and remission of LV dysfunction: LV ejection fraction (EF)≥ 50%) and defining the incidence and predictors of such a process.
Methods: CRT devices were successfully implanted in 520 consecutive HF patients from 1999 to 2006 (mean age 66 yrs, 82% male gender, NYHA class≥ II, LVEF 28%, QRS 164 ms, 6 minute hall walk distance 302 m) according to conventional indication. Follow-up clinical and echocardiographic data were prospectively collected every 3– 6 months. Continuous variables were stratified in tertiles.
Results: Three patients were lost to follow-up. Over a median follow up of 28 months (IQR: 18–35 months), 26% of patients achieved LV remission (rate: 16 per 100 person year). At univariate analysis female gender (p=.032), non-CAD etiology (p<.001), mitral regurgitation <2/4 (p=.022), higher EF tertile (p<.001), lower diameter and volume tertiles (both p<.001), previous conventional right ventricle pacing (p=.029), and post CRT-paced QRS (p=.008) predicted remission. At multivariate analysis, non-CAD etiology, LVEF 30 –35%, and LV end-diastolic volume (EDV) < 180 ml were strongly associated with remission (all p<.001). Concomitance of these 3 factors yielded a significantly higher remission rate compared to either no or only 1 factor (respectively 60 vs. 7 and 11 per 100 person year, p<.001).
Conclusions: In our experience, HF remission after CRT was found to occur in over 25% of patients. Non-CAD etiology and moderately compromised LV function at baseline may easily predict this process.