Long-term cardiac reverse remodeling after cardiac resynchronization therapy.

Autor: Alvarez-Alvarez B; Cardiology Department Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain., García-Seara J; Arrhythmia Unit Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain., Martínez-Sande JL; Arrhythmia Unit Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain., Rodríguez-Mañero M; Arrhythmia Unit Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain., Fernández López XA; Arrhythmia Unit Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain., González-Melchor L; Arrhythmia Unit Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain., Iglesias-Alvarez D; Cardiology Department Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain., Gude F; Epidemiology Department Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain., Díaz-Louzao C; Statistics and Biomedical Data Science Research Group (GRID-BDS) Department of Statistics Mathematical Analysis and Optimization University of Santiago de Compostela Santiago de Compostela Spain., González-Juanatey JR; Cardiology Department Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain.
Jazyk: angličtina
Zdroj: Journal of arrhythmia [J Arrhythm] 2021 Mar 21; Vol. 37 (3), pp. 653-659. Date of Electronic Publication: 2021 Mar 21 (Print Publication: 2021).
DOI: 10.1002/joa3.12527
Abstrakt: Introduction: The benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) have been observed in the first year. However, there are few data on long-term follow-up and the effect of changes of LVEF on mortality. This study aimed to assess the LV remodeling after CRT implantation and the probable effect of changes in LVEF with repeated measures on mortality over time in a real-world registry.
Methods: Among our cohort of 328 consecutive CRT patients, mixed model effect analysis have been made to describe the temporal evolution of LVEF and LVESV changes over time up with several explanatory variables. Besides, the effect of LVEF along time on the probability of mortality was evaluated using joint modeling for longitudinal and survival data.
Results: The study population included 328 patients (253 men; 70.2 ± 9.5 years) in 4.2 (2.9) years follow-up. There was an increase in LVEF of 11% and a reduction in LVESV of 42 mL during the first year. These changes are more important during the first year, but slight changes remain during the follow-up. The largest reduction in LVESV occurred in patients with left bundle branch block (LBBB) and the smallest reduction in patients with NYHA IV. The smallest increase in LVEF was an ischemic etiology, longer QRS, and LV electrode in a nonlateral vein. Besides, the results showed that the LVEF profiles taken during follow-up after CRT were associated with changes in the risk of death.
Conclusion: Reverse remodeling of the left ventricle is observed especially during the first year, but it seems to be maintained later after CRT implantation in a contemporary cohort of patients. Longitudinal measurements could give us additional information at predicting the individual mortality risk after adjusting by age and sex compared to a single LVEF measurement after CRT.
Competing Interests: The authors declare no conflict of interests for this article.
(© 2021 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)
Databáze: MEDLINE
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