Don't expect left ventricular reverse remodeling after cardiac resynchronization therapy in patients with systolic
Akinori Sairaku1, Yukihiko Yoshida2, Yukiko Nakano1
1Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan.
Insights
Cardiac resynchronization therapy (CRT) is effective for heart failure patients with atrioventricular block (AVB) and left ventricular systolic dysfunction (LVSD). However, LV reverse remodeling is less common in this group compared to standard CRT indications.
Area of Science:
- Cardiology
- Heart Failure Management
- Electrophysiology
Background:
- The BLOCK HF trial identified heart failure patients with atrioventricular block (AVB) and left ventricular systolic dysfunction (LVSD) as potential candidates for cardiac resynchronization therapy (CRT), even with narrow QRS duration.
- This study aimed to compare the clinical response to CRT in patients with AVB and LVSD against those with established CRT indications.
Purpose of the Study:
- To evaluate the effectiveness of CRT in patients with AVB and LVSD.
- To compare clinical outcomes and left ventricular (LV) remodeling between AVB with LVSD patients and those meeting standard CRT criteria.
Main Methods:
- A comparative study involving 3 groups: standard CRT indication (LVEF ≤35%, QRS duration ≥120ms, n=125), CRT upgrade (n=49), and AVB with LVSD (LVEF ≤50%, advanced AVB, n=27).
- Clinical data and CRT response were analyzed across three cardiovascular centers.
- Outcomes assessed included clinical composite score (CCS) improvement, LV end-systolic volume reduction, and 5-year incidence of cardiovascular death or heart failure hospitalization.
Main Results:
- No significant difference in CCS improvement at 6 months post-CRT across the groups (60.8%, 57.1%, 70.4%).
- Patients with AVB and LVSD showed significantly less LV end-systolic volume reduction compared to standard indication and upgrade groups (-5.2±23.9% vs. -35.3±34.7% and -21.4±28.5%, respectively).
- The 5-year incidence of cardiovascular death or heart failure hospitalization was similar across all groups (44%, 55.1%, 44.4%).
Conclusions:
- CRT may offer similar clinical effectiveness for patients with AVB and LVSD as for those with standard indications.
- LV reverse remodeling is less pronounced in patients with AVB and LVSD undergoing CRT.
- These findings suggest careful consideration of CRT benefits and remodeling potential in AVB with LVSD patients.
Background:
The BLOCK HF trial showed that heart failure patients with atrioventricular block (AVB) and left ventricular systolic dysfunction (LVSD) are considered good candidates for cardiac resynchronization therapy (CRT), even though they have a narrow QRS duration. We aimed to compare the clinical response to CRT between patients with AVB combined with LVSD and patients with pre-existing CRT indications.
Methods:
We compared the clinical data on CRT across the following 3 groups in 3 cardiovascular centers; heart failure patients with an LV ejection fraction (LVEF) of ≤35% who had a QRS duration of ≥120ms (standard indication, n=125), those needing an upgrade to CRT (upgrade, n=49), and patients with an LVEF of ≤50% who had advanced AVB (AVB with LVSD, n=27).
Results:
The prevalence of left bundle branch block differed significantly across the groups (87.2%, 98.0% and 40.7%; P<0.001). No inter-group difference was found in the percentage of patients in whom clinical composite score (CCS) assessed 6months after the CRT was improved (60.8%, 57.1% and 70.4%; P=0.67). Whereas, even among the patients with an improved CCS, a significantly smaller LV end-systolic volume reduction after the CRT was seen in the ABV with LVSD group (-35.3±34.7, -21.4±28.5 and -5.2±23.9%; P=0.001). The incidence of cardiovascular death or hospitalization from heart failure within 5years occurred with a similar frequency (44%, 55.1% and 44.4%; P=0.9).
Conclusions:
As compared to patients with preexisting CRT indications, CRT may be similarly effective for patients with AVB and LVSD, however, LV reverse remodeling may be uncommon among them.
Related Concept Videos
01:29Heart Failure II: Pathophysiology
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:25Aortic Regurgitation III: Medical Management
01:20Mitral Regurgitation I: Introduction
01:29Cardiomyopathy V: Interprofessional Care