Predictors of Spontaneous Reverse Remodeling in Mild Heart Failure Patients With Left Ventricular Dysfunction

Autor: Anne-Christine Ruwald, Dorit Knappe, Wojciech Zareba, Scott D. Solomon, David T. Huang, Mohan Rao, Alon Barsheshet, Arthur J. Moss, Anne-Catherine Pouleur, Ilan Goldenberg, Scott McNitt, Andrew Brenyo, Valentina Kutyifa
Rok vydání: 2014
Předmět:
Zdroj: Circulation: Heart Failure. 7:565-572
ISSN: 1941-3297
1941-3289
Popis: Background— There are limited data regarding factors associated with spontaneous left ventricular reverse remodeling (S-LVRR) among mildly symptomatic heart failure (HF) patients and its prognostic implications on clinical outcomes. Methods and Results— Best subsets logistic regression analysis was used to identify factors associated with S-LVRR (defined as ≥15% reduction in left ventricular end-systolic volume at 1-year of follow-up) among 612 patients treated with internal cardioverter defibrillator–only therapy in Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT) and to create a score for the prediction of S-LVRR. Cox proportional hazards regression modeling was used to assess the clinical outcome of all internal cardioverter defibrillator–only patients (n=714) with a high S-LVRR score. S-LVRR occurred in 25% of internal cardioverter defibrillator–only patients. Predictors of S-LVRR included systolic blood pressure≥140 mm Hg, serum creatinineP =0.019) reduction in the risk of HF or death. Treatment with cardiac resynchronization therapy was associated with a significant reduction in the risk of HF or death only among internal cardioverter defibrillator–treated patients with a low (Q1–3) S-LVRR score (hazard ratio=0.55; P P =0.72). Conclusions— Our data suggest that approximately one quarter of mild HF patients eligible for biventricular pacing experience S-LVRR. Combined assessment of clinical factors associated with S-LVRR can be used to identify mild HF patients with a low risk for clinical events without cardiac resynchronization therapy intervention. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00180271.
Databáze: OpenAIRE