Long-Term Impact of Cardiac Resynchronization Therapy in Mild Heart Failure: 5-Year Results From the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) Study

Study Questions:

What is the magnitude and sustained effect of cardiac resynchronization therapy (CRT) among patients with mild heart failure (HF), reduced left ventricular (LV) function, and wide QRS over a prolonged follow-up period?

Methods:

REVERSE was a randomized, double-blind study on CRT in New York Heart Association class I and II HF patients with QRS ≥120 ms and LV ejection fraction (LVEF) ≤40%. After the randomized phase, all were programmed to CRT ON and prospectively followed through 5 years for functional capacity, echocardiography, HF hospitalizations, mortality, and adverse events. The investigators reported the results of the 419 patients initially assigned to CRT ON.

Results:

The mean follow-up time was 54.8 ± 13.0 months. After 2 years, the functional and LV remodeling improvements were maximal. The 6-minute hall walk increased by 18.8 ± 102.3 m and the Minnesota and Kansas City scores improved by 8.2 ± 17.8 and 8.2 ± 17.2 units, respectively. The mean decrease in LV end-systolic volume index and LV end-diastolic volume index was 23.5 ± 34.1 ml/m2 (p < 0.0001) and 25.4 ± 37.0 ml/m2 (p < 0.0001), and the mean increase in LVEF 6.0 ± 10.8% (p < 0.0001) with sustained improvement thereafter. The annualized and 5-year mortality was 2.9 and 13.5%, and the annualized and 5-year rate of death or first HF hospitalization was 6.4 and 28.1%. The 5-year LV lead-related complication rate was 12.5%.

Conclusions:

The authors concluded that in patients with mild HF, CRT produced reverse LV remodeling accompanied by very low mortality and need for HF hospitalization.

Perspective:

The primary finding of this preplanned 5-year analysis from the REVERSE study was that CRT was associated with low rates of HF hospitalization and all-cause mortality over the entire follow-up. This study shows that CRT not only produced large structural changes in mild HF patients within 2 years, but also had sustained long-term effects. The possibility of long-lasting benefit of CRT on HF progression appears to outweigh the risk ,and may warrant better implementation of CRT therapy than is common in today’s practice of medicine. It should be noted that these results may not apply to subjects with more severe HF in whom the natural history and hence the possibility to affect the long-term outcome may be limited.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, Acute Heart Failure

Keywords: Kansas, Minnesota, Heart Failure, Ventricular Remodeling, New York, Ventricular Dysfunction, Left, Hospitalization, Cardiac Resynchronization Therapy


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