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 |
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Rok vydání: | 2014 |
Předmět: |
Male
Canada medicine.medical_specialty Heart Ventricles medicine.medical_treatment Cardiac resynchronization therapy Logistic regression Ventricular Dysfunction Left chemistry.chemical_compound Risk Factors Internal medicine Cox proportional hazards regression medicine Humans Reverse remodeling Aged Heart Failure Creatinine Ventricular Remodeling business.industry Stroke Volume Middle Aged Prognosis medicine.disease United States Defibrillators Implantable Europe Survival Rate chemistry Echocardiography Heart failure Cardiology Female Cardiology and Cardiovascular Medicine business |
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 |
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