Remission of left ventricular systolic dysfunction and of heart failure symptoms after cardiac resynchronization therapy: Temporal pattern and clinical predictors - 09/08/11
, François Regoli, MD, PhD a, Carlo Ceriotti, MD a, Paola Galimberti, MD a, Renato Bragato, MD a, Stefano De Vita, MD a, Daniela Pini, MD a, Bruno Andreuzzi, MD a, Maurizio Mangiavacchi, MD a, Catherine Klersy, MD bRésumé |
Background |
The aim of the study was to determine whether cardiac resynchronization therapy (CRT) may induce a heart failure (HF) remission phase (recovery to New York Heart Association functional class I-II and regression of left ventricular [LV] dysfunction: LV ejection fraction [EF] ≥50%) and to define the incidence and predictors of such a process.
Methods |
Cardiac resynchronization therapy devices were successfully implanted in 520 consecutive HF patients from 1999 to 2006 (mean age 66 years, 82% male sex, New York Heart Association class ≥II, LVEF 28%, QRS 164 milliseconds, 6-minute hall walk distance 302 m) at our institution. Follow-up data were prospectively collected every 3 to 6 months. Continuous variables were stratified in tertiles.
Results |
Over a median follow-up of 28 months, 26% of patients achieved LV remission (rate: 16 per 100 person-years). At univariate analysis, female sex (P = .032), non–coronary artery disease (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% to 35%, and LV end-diastolic volume <180 mL were strongly associated with HF remission phase (all P < .001). Concomitance of these 3 factors yielded a significantly higher remission rate compared with either no or only 1 factor (respectively, 60 vs 7 and 11 per 100 person-years, P < .001).
Conclusions |
Cardiac resynchronization therapy induces HF remission phase in 26% of patients, even after 3 years. Non-CAD etiology and moderately compromised LV function at baseline may easily predict this process.
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Vol 155 - N° 3
P. 507-514 - mars 2008 Retour au numéro
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