Reverse Remodeling and the Risk of Ventricular Tachyarrhythmias in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy)

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:57

Article

Barsheshet, Alon¹  Wang, Paul J.²  Solomon, Scott D.³  Al-Ahmad, Amin²  Foster, Elyse⁴  Eldar, Michael⁵ 

[1] Univ Rochester, Med Ctr, Heart Res Follow Program, Div Cardiol, Rochester, NY 14642 USA

[2] Stanford Univ, Div Cardiol, Stanford, CA 94305 USA

[3] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Cardiovasc, Boston, MA 02115 USA

[4] Univ Calif San Francisco, Dept Med, San Francisco, CA USA

[5] Chaim Sheba Med Ctr, Inst Heart, IL-52621 Tel Hashomer, Israel

关键词: cardiac resynchronization therapy;    heart failure;    implantable cardioverter-defibrillator;    reverse remodeling;    ventricular arrhythmia;   

DOI  :  10.1016/j.jacc.2010.12.041

来源: Elsevier

【 摘 要 】

Objectives We aimed to evaluate the relationship between echocardiographic response to cardiac resynchronization therapy (CRT) and the risk of subsequent ventricular tachyarrhythmias (VTAs). Background Current data regarding the effect of CRT on the risk of VTA are limited and conflicting. Methods The risk of a first appropriate implantable cardioverter-defibrillator (ICD) therapy for VTA (including ventricular tachycardia, ventricular fibrillation, and ventricular flutter) was compared between high-and low-echocardiographic responders to CRT defibrillator (CRT-D) therapy (defined as >= 25% and <25% reductions, respectively, in left ventricular end-systolic volume [LVESV] at 1 year compared with baseline) and ICD-only patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). Results The cumulative probability of a first VTA at 2 years after assessment of echocardiographic response was highest among low responders to CRT-D (28%), intermediate among ICD-only patients (21%), and lowest among high responders to CRT-D (12%), with p < 0.001 for the overall difference during follow-up. Multivariate analysis showed that high responders to CRT-D experienced a significant 55% reduction in the risk of VTA compared with ICD-only patients (p < 0.001), whereas the risk of VTA was not significantly different between low responders and ICD-only patients (hazard ratio [HR]: 1.26; p = 0.21). Consistently, assessment of response to CRT-D as a continuous measure showed that incremental 10% reductions in left ventricular end-systolic volume were associated with corresponding reductions in the risk of subsequent VTA (HR: 0.80; p < 0.001), VTA/death (HR: 0.79; p < 0.001), ventricular tachycardia (HR: 0.80; p < 0.001), and ventricular fibrillation/ventricular flutter (HR: 0.75; p = 0.044). Conclusions In patients with left ventricular dysfunction enrolled in the MADIT-CRT trial, reverse remodeling was associated with a significant reduction in the risk of subsequent life-threatening VTAs. (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271) (J Am Coll Cardiol 2011; 57:2416-23) (C) 2011 by the American College of Cardiology Foundation

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