Author + information
- Received January 10, 2019
- Revision received July 24, 2019
- Accepted July 26, 2019
- Published online September 16, 2019.
- Syed Y. Naqvi, MD, MSca,∗,
- Anas Jawaid, MDa,∗,
- Katherine Vermilye, MDa,
- Tor Biering-Sørensen, MD, PhDb,
- Ilan Goldenberg, MDa,
- Wojciech Zareba, MD, PhDa,
- Scott McNitt, MSa,
- Bronislava Polonsky, MSa,
- Scott D. Solomon, MDb and
- Valentina Kutyifa, MD, PhDa,∗ ()
- aUniversity of Rochester Medical Center, Rochester, New York
- bBrigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Valentina Kutyifa, Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Boulevard, P.O. Box 653, Rochester, New York 14642.
Objectives The aim of this study was to evaluate the association between improvement in left ventricular end-systolic volume (LVESV) with cardiac resynchronization therapy (CRT) and mortality and whether this relationship was modified by the presence of a left bundle branch block (LBBB) electrocardiographic pattern.
Background Left ventricular reverse remodeling in patients receiving CRT has been shown to predict outcomes. However, the extent to which reverse remodeling contributes to long-term survival is not well understood.
Methods Changes in LVESV were assessed in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) patients receiving CRT with a defibrillator (CRT-D) and echocardiograms available at 1 year (n = 752), stratified by LBBB, relative to long-term all-cause mortality, compared with those with implantable cardioverter-defibrillators (ICDs) only (n = 684).
Results In patients with LBBB, a reduction in LVESV of >35% (median) translated into significantly lower risk for long-term mortality (hazard ratio [HR]: 0.34; p < 0.001), heart failure (HF) events (HR: 0.21; p < 0.001), and HF or death (HR: 0.27; p < 0.001) compared with patients with ICDs only. Patients with reductions in LVESV ≤35% had a significantly lower risk for HF, and HF or death, and a nonsignificantly lower rate of death compared with those with ICDs only (HR: 0.74; p = 0.13). Risk reduction in HF events was uniform across all LVESV quartiles. In patients without LBBB, there was no survival benefit (HR: 0.68; p = 0.271) despite an LVESV reduction greater than the median (>27.6%). CRT-D patients without LBBB with the least reverse remodeling (quartile 1) had a more than 3-fold increased risk for death compared with those with ICDs only (HR: 3.11; p < 0.001).
Conclusions In patients with LBBB, CRT-D-induced reduction in LVESV at 1 year is associated with long-term survival benefit. Despite left ventricular reverse remodeling with CRT-D, there is no survival benefit and potential harm in patients without LBBB.
↵∗ Drs. Naqvi and Jawaid contributed equally to this paper and are joint first authors.
Dr. Kutyifa has received research grants from Boston Scientific, ZOLL, and Biotronik; and consultant fees from Biotronik and ZOLL. Drs. Goldenberg, Zareba, and Solomon have received research grants from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received January 10, 2019.
- Revision received July 24, 2019.
- Accepted July 26, 2019.
- 2019 American College of Cardiology Foundation
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