ACCEL: Can CRT REVERSE Disease Progression In Mildly Symptomatic HF Patients? 5-Year Results Show Persistent Benefits
Cardiac resynchronization therapy (CRT)—with or without an implantable cardioverter-defibrillator—improves quality of life, functional status, exercise capacity, morbidity, and mortality in patients in New York Heart Association (NYHA) class III and IV heart failure (HF) with a prolonged QRS. Additionally, CRT contributes to improving left ventricular (LV) structure and function in these patients. So what about patients with asymptomatic or mildly symptomatic HF? Might CRT improve their well-being through LV reverse remodeling?
To answer this question, US and European researchers conducted the randomized, double-blind Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) trial.1 A total of 610 patients with NYHA class II or I (previously symptomatic) HF were enrolled. Participants had a QRS ≥120 ms with an average of 153 ms, making the QRS slightly less than other trials of patients with more advanced disease. Patients all had an LV ejection fraction ≤40%. So, moderately sick HF patients with moderately broad QRS intervals. All patients received a CRT device with or without a defibrillator and were randomized either to active CRT (CRT ON) or no CRT (CRT OFF, which was the control group) plus optimal medical therapy.
The primary endpoint was a global score based on all-cause mortality, HF hospitalizations, crossover due to worsening HF, NYHA class, and patient global assessment; patients were scored as improved, unchanged, or worsened. The prospectively-powered secondary endpoint was LV end-systolic volume index.
REVERSE at 5 Years
Average follow-up was 54.8±13.0 months, with good compliance: 95%, 89%, and 86% of non-deceased patients completed follow-up at 3, 4, and 5 years post-randomization, respectively.
Reverse remodeling reached its maximum within 2 years and sustained thereafter. The annualized mortality was 2.9%, yielding a 5-year mortality of 13.5%. The total 5-year rate of death or first HF-related hospitalization was 28.1%, with a stable event rate over time and an annual rate of 6.4%.
1. Linde C, Gold MR, Abraham WT, et al. Eur Heart J. 2013 May 2. [Epub ahead of print]
To listen to an interview with Cecilia Linde, MD, about CRT for HF, visit youtube.cswnews.org . The interview was conducted by Steven E. Nissen, MD.
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