Clinical phenotypes and outcomes associated with improved left ventricular ejection fraction after biventricular
Sameer A Kunte1, Lurdes Y T Inoue2, William T Abraham3
1Division of Cardiology, Duke University School of Medicine, Durham, NC, USA. sameer.kunte@duke.edu.
Summary
Left ventricular ejection fraction (LVEF) improvement after cardiac resynchronization therapy (CRT) is linked to better patient outcomes. Patients with improved LVEF were less likely to have ischemic cardiomyopathy and more likely to have LBBB.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Not all patients experience left ventricular ejection fraction (LVEF) improvement after cardiac resynchronization therapy (CRT).
- Understanding factors influencing LVEF response is crucial for optimizing CRT outcomes.
Purpose of the Study:
- To identify patient characteristics associated with LVEF improvement post-CRT.
- To evaluate the impact of LVEF improvement on clinical outcomes.
Main Methods:
- Analysis of patients from REVERSE, MADIT-CRT, and BLOCK-HF trials who received CRT.
- Comparison of characteristics between patients with and without LVEF improvement using statistical tests.
- Survival analysis using Kaplan-Meier curves and Cox Proportional-Hazards models to assess time to death or heart failure hospitalization (HFH).
Main Results:
- Of 1065 patients, 85% showed LVEF improvement.
- Improved LVEF was associated with lower rates of ischemic cardiomyopathy (ICM) and higher rates of left bundle branch block (LBBB).
- Patients with improved LVEF had significantly longer time to HFH or death (HR 0.40) and death alone (HR 0.27).
Conclusions:
- LVEF improvement post-CRT is associated with specific patient profiles (less ICM, more LBBB, longer QRS duration).
- Improved LVEF is a significant predictor of better clinical outcomes, including reduced mortality and HFH.
