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Updated: May 11, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac
Cheuk-Man Yu1, Gabe B Bleeker, Jeffrey Wing-Hong Fung
1Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong. cmyu@cuhk.edu.hk
Insights
A 10% reduction in left ventricular end-systolic volume (LVESV) after cardiac resynchronization therapy (CRT) indicates significant reverse remodeling. This improvement predicts better long-term survival and fewer heart failure events in patients with severe heart failure.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Interventions
Background:
- Cardiac resynchronization therapy (CRT) improves left ventricular (LV) function and survival in severe heart failure.
- The long-term prognostic significance of LV reverse remodeling and its clinically relevant extent after CRT remain unclear.
Purpose of the Study:
- To determine if LV reverse remodeling after CRT predicts long-term prognosis.
- To identify the specific extent of LV reverse remodeling that is clinically relevant for patient outcomes.
Main Methods:
- 141 patients with advanced heart failure receiving CRT were followed for a mean of 695 days.
- Left ventricular end-systolic volume (LVESV) reduction at 3-6 months was analyzed using receiver operating characteristic (ROC) curves to find the mortality prediction cutoff.
- Kaplan-Meier survival and Cox regression analyses compared outcomes between responders and non-responders to reverse remodeling.
Main Results:
- A reduction in LVESV of ≥9.5% was identified as the optimal cutoff for predicting mortality (70% sensitivity, 70% specificity for all-cause; 87% sensitivity, 69% specificity for cardiovascular).
- 61.7% of patients were classified as responders to reverse remodeling.
- Responders demonstrated significantly lower all-cause mortality (6.9% vs. 30.6%), cardiovascular mortality (2.3% vs. 24.1%), and heart failure events (11.5% vs. 33.3%) compared to non-responders.
- LVESV change was the strongest predictor of mortality, outperforming clinical parameters.
Conclusions:
- A ≥10% reduction in LVESV signifies clinically relevant reverse remodeling post-CRT.
- This degree of reverse remodeling is a powerful predictor of reduced long-term mortality and heart failure events.
- Assessing volumetric changes post-intervention provides valuable prognostic information for heart failure patients.
Background:
In patients with severe heart failure and dilated cardiomyopathy, cardiac resynchronization therapy (CRT) improves left ventricular (LV) systolic function associated with LV reverse remodeling and favorable 1-year survival. However, it is unknown whether LV reverse remodeling translates into a better long-term prognosis and what extent of reverse remodeling is clinically relevant, which were investigated in this study.
Methods And Results:
Patients (n=141) with advanced heart failure (mean+/-SD age, 64+/-11 years; 73% men) who received CRT were followed up for a mean (+/-SD) of 695+/-491 days. The extent of reduction in LV end-systolic volume (LVESV) at 3 to 6 months relative to baseline was examined for its predictive value on long-term clinical outcome. The cutoff value for LV reverse remodeling in predicting mortality was derived from the receiver operating characteristic curve. Then the relation between potential predictors of mortality and heart failure hospitalizations were compared by Kaplan-Meier survival analysis, followed by Cox regression analysis. There were 22 (15.6%) deaths, mostly due to heart failure or sudden cardiac death. The receiver operating characteristic curve found that a reduction in LVESV of > or =9.5% had a sensitivity of 70% and specificity of 70% in predicting all-cause mortality and of 87% and 69%, respectively, for cardiovascular mortality. With this cutoff value, there were 87 (61.7%) responders to reverse remodeling. In Kaplan-Meier survival analysis, responders had significantly lower all-cause morality (6.9% versus 30.6%, log-rank chi2=13.26, P=0.0003), cardiovascular mortality (2.3% versus 24.1%, log-rank chi2=17.1, P<0.0001), and heart failure events (11.5% versus 33.3%, log-rank chi2=8.71, P=0.0032) than nonresponders. In the Cox regression analysis model, the change in LVESV was the single most important predictor of all-cause (beta=1.048, 95% confidence interval=1.019 to 1.078, P=0.001) and cardiovascular (beta=1.072, 95% confidence interval=1.033 to 1.112, P<0.001) mortality. Clinical parameters were unable to predict any outcome event.
Conclusions:
A reduction in LVESV of 10% signifies clinically relevant reverse remodeling, which is a strong predictor of lower long-term mortality and heart failure events. This study suggests that assessing volumetric changes after an intervention in patients with heart failure provides information predictive of natural history outcomes.
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