Long-term cardiac reverse remodeling after cardiac resynchronization therapy
Belén Alvarez-Alvarez1, Javier García-Seara2, Jose L Martínez-Sande2
1Cardiology Department Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain.
Insights
Cardiac resynchronization therapy (CRT) improves heart function, with significant left ventricular remodeling observed in the first year. Longitudinal monitoring of left ventricular ejection fraction (LVEF) after CRT is crucial for predicting long-term mortality risk.
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.
Introduction:
The benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) have been observed in the first year. However, there are few data on long-term follow-up and the effect of changes of LVEF on mortality. This study aimed to assess the LV remodeling after CRT implantation and the probable effect of changes in LVEF with repeated measures on mortality over time in a real-world registry.
Methods:
Among our cohort of 328 consecutive CRT patients, mixed model effect analysis have been made to describe the temporal evolution of LVEF and LVESV changes over time up with several explanatory variables. Besides, the effect of LVEF along time on the probability of mortality was evaluated using joint modeling for longitudinal and survival data.
Results:
The study population included 328 patients (253 men; 70.2 ± 9.5 years) in 4.2 (2.9) years follow-up. There was an increase in LVEF of 11% and a reduction in LVESV of 42 mL during the first year. These changes are more important during the first year, but slight changes remain during the follow-up. The largest reduction in LVESV occurred in patients with left bundle branch block (LBBB) and the smallest reduction in patients with NYHA IV. The smallest increase in LVEF was an ischemic etiology, longer QRS, and LV electrode in a nonlateral vein. Besides, the results showed that the LVEF profiles taken during follow-up after CRT were associated with changes in the risk of death.
Conclusion:
Reverse remodeling of the left ventricle is observed especially during the first year, but it seems to be maintained later after CRT implantation in a contemporary cohort of patients. Longitudinal measurements could give us additional information at predicting the individual mortality risk after adjusting by age and sex compared to a single LVEF measurement after CRT.
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