Long-term cardiac reverse remodeling after cardiac resynchronization therapy

Area of Science:

• Cardiology
• Medical Technology
• Heart Failure Management

Background:

• Cardiac resynchronization therapy (CRT) benefits heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) within the first year.
• Limited data exist on long-term CRT effects and the impact of evolving LVEF on mortality.
• Real-world data on LV remodeling and LVEF changes post-CRT are needed.

Purpose of the Study:

• To assess left ventricular (LV) remodeling following CRT implantation.
• To evaluate the effect of longitudinal LVEF changes on mortality over time.
• To analyze CRT outcomes in a real-world patient registry.

Main Methods:

• Mixed-effects modeling analyzed temporal changes in LVEF and LV end-systolic volume (LVESV) in 328 CRT patients.
• Joint modeling of longitudinal and survival data assessed the relationship between LVEF and mortality.
• Follow-up duration averaged 4.2 years.

Main Results:

• Significant LVEF increase (11%) and LVESV reduction (42 mL) occurred within the first year post-CRT, with sustained changes.
• Left bundle branch block (LBBB) patients showed the greatest LVESV reduction; NYHA IV patients showed the smallest.
• Ischemic etiology, longer QRS duration, and non-lateral LV lead placement were associated with smaller LVEF increases.
• Longitudinal LVEF profiles post-CRT correlated with mortality risk.

Conclusions:

• Left ventricular reverse remodeling is prominent in the first year after CRT and is maintained long-term.
• Repeated LVEF measurements provide superior individual mortality risk prediction compared to single measurements, even after adjusting for age and sex.