Effect of cardiac resynchronization therapy on reverse remodeling and relation to outcome: multicenter automatic
Scott D Solomon1, Elyse Foster, Mikhail Bourgoun
1Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. ssolomon@rics.bwh.harvard.edu
Insights
Cardiac resynchronization therapy (CRT) combined with an implantable cardioverter defibrillator (ICD) significantly improves cardiac function and size in heart failure patients. These positive echocardiographic changes are linked to better long-term outcomes, reducing death or heart failure events.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Technology
Background:
- Cardiac resynchronization therapy (CRT) with an implantable cardioverter defibrillator (ICD) shows promise for mildly symptomatic heart failure patients with left ventricular dysfunction and wide QRS complex.
- Previous studies indicated CRT plus ICD reduces risks of death or heart failure events compared to ICD alone.
Purpose of the Study:
- To assess echocardiographic changes in patients from the MADIT-CRT trial.
- To determine if outcome improvements with CRT plus ICD are associated with favorable alterations in cardiac size and function.
Main Methods:
- 1,820 patients were randomized to CRT plus ICD or ICD alone (3:2 ratio).
- Echocardiographic studies were performed at baseline and 12 months in 1,372 patients.
- Changes in cardiac size and performance were compared between groups, and their relationship to subsequent outcomes was assessed.
Main Results:
- The CRT plus ICD group showed greater improvements in left ventricular end-diastolic volume index, left ventricular end-systolic volume index, left ventricular ejection fraction, left atrial volume index, and right ventricular fractional area change compared to the ICD-only group.
- A 10% decrease in end-diastolic volume at 1 year was associated with a 40% reduction in the risk of subsequent death or heart failure (P<0.001).
Conclusions:
- CRT significantly improves cardiac size and performance in patients with mildly symptomatic heart failure compared to an ICD-only strategy.
- The observed improvements in cardiac measures accounted for the benefits in patient outcomes.
Background:
Cardiac resynchronization therapy (CRT) plus implantation of an implantable cardioverter defibrillator (ICD) reduced the risk of death or heart failure event in patients with mildly symptomatic heart failure, left ventricular dysfunction, and wide QRS complex compared with an ICD only. We assessed echocardiographic changes in patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial: Cardiac Resynchronization Therapy) to evaluate whether the improvement in outcomes with CRT plus an ICD was associated with favorable alterations in cardiac size and function.
Methods And Results:
A total of 1,820 patients were randomly assigned to CRT plus an ICD or to an ICD only in a 3:2 ratio. Echocardiographic studies were obtained at baseline and 12 months later in 1,372 patients. We compared changes in cardiac size and performance between treatment groups and assessed the relationship between these changes over the first year, as well as subsequent outcomes. Compared with the ICD-only group, the CRT-plus-ICD group had greater improvement in left ventricular end-diastolic volume index (-26.2 versus -7.4 mL/m(2)), left ventricular end-systolic volume index (-28.7 versus -9.1 mL/m(2)), left ventricular ejection fraction (11% versus 3%), left atrial volume index (-11.9 versus -4.7 mL/m(2)), and right ventricular fractional area change (8% versus 5%; P<0.001 for all). Improvement in end-diastolic volume at 1 year was predictive of subsequent death or heart failure, with adjustment for baseline covariates and treatment group; each 10% decrease in end-diastolic volume was associated with a 40% reduction in risk (P<0.001).
Conclusions:
CRT resulted in significant improvement in cardiac size and performance compared with an ICD-only strategy in patients with mildly symptomatic heart failure. Improvement in these measures accounted for the outcomes benefit. Clinical Trial Registration Information- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.
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