Cardiac Resynchronization Induces Major Structural and Functional Reverse Remodeling in Patients With New York Heart Association Class I/II Heart Failure

Article

关键词: LEFT-VENTRICULAR DYSFUNCTION;    THERAPY;    TRIAL;    DESIGN;    CARDIOMYOPATHY;    DEFIBRILLATOR;    GUIDELINES;    INFARCTION;    RATIONALE;    SYMPTOMS;   

DOI  :  10.1161/CIRCULATIONAHA.108.818724

来源: SCIE

【 摘 要 】

Background-Cardiac resynchronization therapy (CRT) improves LV structure, function, and clinical outcomes in New York Heart Association class III/IV heart failure with prolonged QRS. It is not known whether patients with New York Heart Association class I/II systolic heart failure exhibit left ventricular (LV) reverse remodeling with CRT or whether reverse remodeling is modified by the cause of heart failure. Methods and Results-Six hundred ten patients with New York Heart Association class I/II heart failure, QRS duration >= 120 ms, LV end-diastolic dimension >= 55 mm, and LV ejection fraction <= 40% were randomized to active therapy (CRT on; n = 419) or control (CRT off; n = 191) for 12 months. Doppler echocardiograms were recorded at baseline, before hospital discharge, and at 6 and 12 months. When CRT was turned on initially, immediate changes occurred in LV volumes and ejection fraction; however, these changes did not correlate with the long-term changes (12 months) in LV end-systolic (r = 0.11, P = 0.31) or end-diastolic (r = 0.10, P = 0.38) volume indexes or LV ejection fraction (r = 0.07, P = 0.72). LV end-diastolic and end-systolic volume indexes decreased in patients with CRT turned on (both P < 0.001 compared with CRT off), whereas LV ejection fraction in CRT-on patients increased (P < 0.0001 compared with CRT off) from baseline through 12 months. LV mass, mitral regurgitation, and LV diastolic function did not change in either group by 12 months; however, there was a 3-fold greater reduction in LV end-diastolic and end-systolic volume indexes and a 3-fold greater increase in LV ejection fraction in patients with nonischemic causes of heart failure. Conclusions-CRT in patients with New York Heart Association I/II resulted in major structural and functional reverse remodeling at 1 year, with the greatest changes occurring in patients with a nonischemic cause of heart failure. CRT may interrupt the natural disease progression in these patients. Clinical Trial Registration-Clinicaltrials. gov Identifier: NCT00271154. (Circulation. 2009;120:1858-1865.)

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