Association of left ventricular remodeling with cardiac resynchronization therapy outcomes.

Autor:	Gold MR; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: goldmr@musc.edu., Rickard J; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Daubert JC; Faculty of Medicine, University of Rennes 1, CIC IT, INSERM 642, Rennes, France., Cerkvenik J; Cardiac Rhythm Management, Medtronic Inc., Minneapolis, Minnesota., Linde C; Department of Medicine, Cardiology Unit, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2023 Feb; Vol. 20 (2), pp. 173-180. Date of Electronic Publication: 2022 Nov 25.
DOI:	10.1016/j.hrthm.2022.11.016
Abstrakt:	Background: Cardiac resynchronization therapy (CRT) response stratified by left ventricular (LV) remodeling revealed differing mortality profiles for distinct patient cohorts. Measuring functional end points, as well as mortality, may better assess CRT efficacy and inform patient management. However, the association between LV remodeling and functional outcomes after CRT is not well understood. Objective: The purpose of this study was to evaluate long-term CRT outcomes by extent of LV remodeling. Methods: REsynchronization reVErses Remodeling in Systolic Left vEntricular dysfunction (ClinicalTrials.gov identifier NCT00271154) was a prospective, double-blind, randomized trial of CRT. Subjects were classified on the basis of LV end-systolic volume (LVESV) change from baseline to 6 months post-CRT: worsened (increase), stabilized (0%-≤15% reduction), responder (>15%-<30% reduction), and super-responder (≥30% reduction). Subjects were evaluated annually for 5 years. Results: The analyses included 353 subjects randomized to CRT-ON arm. All-cause mortality was higher in the worsened group than in the other 3 response groups (29.8% vs 8.0%; P < .0001), with no difference in survival among those groups (P = .87). A significant interaction between the LVESV group and time was observed for health status and quality of life (P = .02 for both). The interaction was not significant for 6-minute hall walk (P = .79); however, super-responders had increased walk distance compared with the other 3 response groups (P = .03). Conclusion: Preventing further increase in LVESV with CRT was associated with reduced mortality, whereas functional measure improvement was associated with LV remodeling magnitude. These results support the consideration of functional and mortality end points to assess CRT efficacy and provide further evidence that the dichotomous "responder and nonresponder" classification should be modified. (Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu