435 Left ventricular reverse remodeling and angiotensin ii receptor blocker neprilysin inhibitor - a real-world data

Abstract BACKGROUND Although sacubitril/valsartan (ARNI) improves the NYHA functional class and prognosis in patients with heart failure with reduced ejection fraction (HFrEF), its impact on reverse remodelling is uncertain. We assessed left ventricular reverse remodeling in a cohort of HFrEF patients treated with ARNI. METHODS We conducted a single-centre, retrospective, observational study of 200 HFrEF patients started on ARNI during 2018. Of these, we analysed 100 patients treated with the maximum, target dose (97/103 mg bid). Baseline clinical, laboratory and demographic characteristics were evaluated and a clinical and echocardiographic follow-up, including left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and mitral valve regurgitation (MR), were conducted from ARNI initiation to a 3-month landmark. RESULTS Mean age was 59 ± 13 years and 85% were male. At baseline, 63% were on NYHA II, 34% in NYHA III and 3% in NYHA IV functional class. Mean systolic blood pressure was 125 ± 16 mmHg, median NT-proBNP was 773 pg/dL (IQR 386-1569) and mean LVEF 27 ± 7%. Median time between initiation of the drug and reaching the target dose was 10 weeks. Functional class significantly improved; at baseline, 37% of patients were in NYHA III-IV; 3 months after target dose, only 6% remained in NYHA III-IV (p = 0.005). Half of patients (48.6%) improved LVEF (from 27 ± 7% to 31 ± 10%, mean increase 4.2 ± 8.8%; 95%CI 2.1 to 6.3, p < 0.001) and in one quarter (24.6%) LVEF improved over 35% (p < 0.001). In a echocardiographic subgroup analysis, including a random sample of 35 patients, we found a significant improvement in GLS 1.5 ± 2.9 (95%CI 0.4 to 2.6%, p = 0.009), a significant decrease in LVESV and LVEDV 29 ± 3 mL (95%CI -42.6mL to -15.4mL, p < 0.001) and 31 ± 47ml (95% CI -48 to -15, p < 0.001), respectively, and a significant improvement in MR severity (p = 0.001). CONCLUSIONS We observed that in an HFrEF patient population treated with ARNI there was a significant clinical improvement, who may be explained by a robust impact on reverse remodelling, even on a short-time of follow-up. An interesting finding was that 24.6% improved LVEF above the 35% cut-off, and therefore lost an indication for a prophylactic implantable cardioverter defibrillator.

Download Full-text

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Cardiology ◽

10.1159/000505148 ◽

2020 ◽

Vol 145 (5) ◽

pp. 275-282 ◽

Cited By ~ 2

Author(s):

Pablo Díez-Villanueva ◽

Lourdes Vicent ◽

Francisco de la Cuerda ◽

Alberto Esteban-Fernández ◽

Manuel Gómez-Bueno ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Ventricular ◽

Functional Class ◽

Ventricular Ejection ◽

Cardiac Resynchronization ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Background: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. Methods: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). Results: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13–0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). Conclusions: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.

Download Full-text

Clinical Phenotypes and Prognosis of Dilated Cardiomyopathy Caused by Truncating Variants in the TTN Gene

Circulation Heart Failure ◽

10.1161/circheartfailure.119.006832 ◽

2020 ◽

Vol 13 (10) ◽

Author(s):

Mohammed Majid Akhtar ◽

Massimiliano Lorenzini ◽

Marcos Cicerchia ◽

Juan Pablo Ochoa ◽

Thomas Morris Hey ◽

...

Keyword(s):

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Ventricular Ejection Fraction ◽

End Point ◽

Left Ventricular Reverse Remodeling ◽

Malignant Ventricular Arrhythmia

Background: Truncating variants in the TTN gene (TTNtv) are the commonest cause of heritable dilated cardiomyopathy. This study aimed to study the phenotypes and outcomes of TTNtv carriers. Methods: Five hundred thirty-seven individuals (61% men; 317 probands) with TTNtv were recruited in 14 centers (372 [69%] with baseline left ventricular systolic dysfunction [LVSD]). Baseline and longitudinal clinical data were obtained. The primary end point was a composite of malignant ventricular arrhythmia and end-stage heart failure. The secondary end point was left ventricular reverse remodeling (left ventricular ejection fraction increase by ≥10% or normalization to ≥50%). Results: Median follow-up was 49 (18–105) months. Men developed LVSD more frequently and earlier than women (45±14 versus 49±16 years, respectively; P =0.04). By final evaluation, 31%, 45%, and 56% had atrial fibrillation, frequent ventricular ectopy, and nonsustained ventricular tachycardia, respectively. Seventy-six (14.2%) individuals reached the primary end point (52 [68%] end-stage heart failure events, 24 [32%] malignant ventricular arrhythmia events). Malignant ventricular arrhythmia end points most commonly occurred in patients with severe LVSD. Male sex (hazard ratio, 1.89 [95% CI, 1.04–3.44]; P =0.04) and left ventricular ejection fraction (per 10% decrement from left ventricular ejection fraction, 50%; hazard ratio, 1.63 [95% CI, 1.30–2.04]; P <0.001) were independent predictors of the primary end point. Two hundred seven of 300 (69%) patients with LVSD had evidence of left ventricular reverse remodeling. In a subgroup of 29 of 74 (39%) patients with initial left ventricular reverse remodeling, there was a subsequent left ventricular ejection fraction decrement. TTNtv location was not associated with statistically significant differences in baseline clinical characteristics, left ventricular reverse remodeling, or outcomes on multivariable analysis ( P =0.07). Conclusions: TTNtv is characterized by frequent arrhythmia, but malignant ventricular arrhythmias are most commonly associated with severe LVSD. Male sex and LVSD are independent predictors of outcomes. Mutation location does not impact clinical phenotype or outcomes.

Download Full-text

P818 Association between baseline left ventricular longitudinal strain and follow-up left ventricular ejection fraction in patients with dilated cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.470 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I H Jung ◽

Y S Byun ◽

J H Park

Keyword(s):

Ejection Fraction ◽

Longitudinal Strain ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Lv Function ◽

Ventricular Ejection Fraction

Abstract Funding Acknowledgements no Background Left ventricular global longitudinal strain (LV GLS) offers sensitive and reproducible measurement of myocardial dysfunction. The authors sought to evaluate whether LV GLS at the time of diagnosis may predict LV reverse remodeling (LVRR) in DCM patients with sinus rhythm and also investigate the relationship between baseline LV GLS and follow-up LVEF. Methods We enrolled patients with DCM who had been initially diagnosed, evaluated, and followed at our institute. Results During the mean follow-up duration of 37.3 ± 21.7 months, LVRR occurred in 28% of patients (n = 45) within 14.7 ± 10.0 months of medical therapy. The initial LV ejection fraction (LVEF) of patients who recovered LV function was 26.1 ± 7.9% and was not different from the value of 27.1 ± 7.4% (p = 0.49) of those who did not recover. There was a moderate and highly significant correlation between baseline LV GLS and follow-up LVEF (r = 0.717; p <0.001). Conclusion There was a significant correlation between baseline LV GLS and follow-up LVEF in this population. Baseline Follow-up Difference (95% CI) p-value All patients (n = 160) LVEDDI, mm/m2 35.6 ± 6.6 35.6 ± 6.6 -2.7 (-3.4 to -2.0) <0.001 LVESDI, mm/m2 30.3 ± 6.1 26.6 ± 6.6 -3.7 (-4.6 to -2.8) <0.001 LVEDVI, mL/m2 95.0 ± 30.7 74.3 ± 30.2 -20.7 (-25.6 to -15.8) <0.001 LVESVI, mL/m2 70.0 ± 24.8 50.2 ± 26.8 -19.8 (-24.2 to -15.4) <0.001 LVEF, % 26.8 ± 7.5 33.9 ± 12.6 7.2 (5.2 to 9.2) <0.001 LV GLS (-%) 9.2 ± 3.1 11.0 ± 4.8 1.8 (1.3 to 2.2) <0.001 Patients without LVRR (n = 115) LVEDDI, mm/m2 34.9 ± 6.8 34.1 ± 6.8 -0.8 (-1.3 to -0.3) 0.002 LVESDI, mm/m2 29.5 ± 6.1 28.4 ± 6.4 -1.4 (-1.8 to -0.4) 0.002 LVEDVI, mL/m2 92.0 ± 30.5 83.4 ± 29.8 -8.6 (-12.4 to -4.8) <0.001 LVESVI, mL/m2 67.1 ± 24.4 59.5 ± 25.3 -7.6 (-10.9 to -4.3) <0.001 LVEF, % 27.1 ± 7.4 27.8 ± 7.4 0.7 (-0.2 to 1.6) 0.126 LV GLS (-%) 8.2 ± 2.9 8.7 ± 3.2 0.5 (0.7 to 3.6) <0.001 Patients with LVRR (n = 45) LVEDDI, mm/m2 37.4 ± 5.5 29.8 ± 5.2 -7.5 (-9.1 to -6.0) <0.001 LVESDI, mm/m2 32.2 ± 5.7 21.9 ± 4.4 -10.3 (-11.9 to -8.6) <0.001 LVEDVI, mL/m2 102.7 ± 30.2 51.1 ± 15.0 -51.7 (-61.6 to -41.7) <0.001 LVESVI, mL/m2 77.3 ± 24.5 26.4 ± 11.3 -50.9 (-58.8 to -43.1) <0.001 LVEF, % 26.1 ± 7.9 49.4 ± 9.5 23.9 (20.4 to 27.5) <0.001 LV GLS (-%) 11.9 ± 1.6 16.9 ± 2.7 5.1 (4.2 to 5.9) <0.001 Baseline and Follow-up LV Functional Echocardiographic Data Abstract P818 Figure.

Download Full-text

Abstract 3355: Relationship Between Electrocardiographic Remodeling, Mechanical Remodeling and the Occurrence of Appropriate Therapy in Biventricular Implantable Cardioverter Defibrillator Patients

Circulation ◽

10.1161/circ.116.suppl_16.ii_756-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Nicolas Lellouche ◽

Carlos De Diego ◽

Gina Akopyan ◽

David A Cesario ◽

Osamu Fujimura ◽

...

Keyword(s):

Implantable Cardioverter Defibrillator ◽

Qt Dispersion ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Icd Therapy ◽

Cardioverter Defibrillator ◽

Reverse Remodelling ◽

Mechanical Remodeling

Background: Cardiac Resynchronization Therapy (CRT) is associated with reverse left ventricular (LV) remodeling. However, the effect of CRT on electrical remodeling, reverse mechanical remodeling, occurrence of ventricular arrhythmias is not well established. Methods: D ata from 45 patients who underwent implantable cardioverter defibrillator(ICD)-CRT implantation was retrospectively analyzed. Patients had New York Heart Association (NYHA) functional class III or IV heart failure symptoms, left ventricular ejection fraction (LVEF) <35%, and QRS duration >130 ms or QRS ≤130ms with left intraventricular dyssynchrony. Significant LV reverse remodeling was defined by a decrease of left ventricular end diastolic diameter (LVEDd) by at least 10% after 1 year of follow up. Electrocardiographic indices of dispersion of repolarization (DR) (QTc, T peak-Tend (Tp-e) and their dispersion) were measured immediately and 1 year after implantation. The occurrence of appropriate ICD therapy was noted for each patient. Results: Patients with significant LV reverse remodeling (n=21) and without LV reverse remodeling (n=24) had similar baseline characteristics. After one year of follow up, patients with LV reverse remodeling exhibited a significant decrease in DR parameters (Tp-e, QT dispersion and Tp-e dispersion), and lower rate of appropriate ICD therapy (log rank p=0.002), compared to those without reverse remodeling who experienced an increase in DR parameters (QT dispersion and Tp-e dispersion), figure 1 . Conclusion: Mechanical LV reverse remodeling is associated with an electrical reverse remodelling and a lower rate of appropriate ICD therapy. Figure 1: Occurence of appropriate CD therapy according to LV reverse remodelling

Download Full-text

Safety and efficacy outcomes at 1 year after MitraClip therapy for percutaneous mitral valve repair in patients with severe mitral regurgitation: the Egyptian experience

The Egyptian Heart Journal ◽

10.1186/s43044-021-00166-5 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Radwa Abdullah Elbelbesy ◽

Ahmed Mohsen Elsawah ◽

Ahmed Shafie Ammar ◽

Hazem Abdelmohsen Khamis ◽

Islam Elsayed Shehata

Keyword(s):

Mitral Valve ◽

Ejection Fraction ◽

Mitral Valve Repair ◽

Left Ventricular ◽

Functional Class ◽

Left Ventricular Ejection ◽

Valve Repair ◽

Ventricular Ejection Fraction ◽

Percutaneous Mitral Valve Repair

Abstract Background Our aim was to assess safety and efficacy outcomes at 1 year after MitraClip for percutaneous mitral valve repair in patients with severe mitral regurgitation. Twenty consecutive patients with significant MR (GIII or GIV) were selected according to the AHA/ACC guidelines from June 2016 to June 2019 and underwent percutaneous edge-to-edge mitral valve repair using MitraClip with a whole 1 year follow-up following the procedure. The primary acute safety endpoint was a 30-day freedom from any of the major adverse events (MAEs) or rehospitalization for heart failure. The primary efficacy endpoint was acute procedural success defined as clip implant with an improvement of MR to ≤ grade II, based on current guidelines, NYHA class, ejection fraction, and the left atrium size during follow-up. Results Mean age of the studied population was 66.8 ± 10 years and about 85% were males. All patients presented with NYHA > 2. EuroSCORE ranged between 7 and 15. Patients varied regarding their HAS-BLED score. None of them experienced MAEs at 30 days. Patients showed significant improvement of NHYA functional class, and all echocardiographic measurements such as left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction, left atrium volume index and MR grade. They also showed significant improvement of right-side heart failure manifestations (lower limb edema, S3 gallop, neck veins congestion), and laboratory value (the mean Hb levels significantly increased from 11.96 ± 1.57 to 12.97 ± 1.36, while the median CRP significantly decreased from 7 (3-9) to 2 (1-3). As well, the median Pro-BNP significantly decreased from 89.5 (73-380) to 66.5 (53.5-151) following MV clipping. During the whole follow-up period, there was dramatic improvement in the NHYA functional class, echocardiographic assessment including left ventricular ejection fraction, and mitral regurge grade. During follow-up, four patients (20%) developed complications. There was no statistical difference between patients who developed complications and those who did not regarding their age (75.25 ± 12.42 versus 64.63 ± 9.21, respectively), BSA (1.69 ± 0.11 versus 1.79 ± 0.22, respectively), gender (75% versus 87.5% males respectively), MR etiology (75% versus 50% ischemic, 25% versus 50% non-ischemic), or NYHA pre- or post-mitral clipping. However, the median EuroSCORE was significantly higher in the complicated group (13, IQR= 11.5-14.5) than the non-complicated group (9.5, IQR=8.5-11.5). Conclusion Percutaneous usage of MitraClip for mitral valve repair showed favorable reliability and better clinical outcomes. Trial registration ZU-IRB#2481-17-2-2016 Registered 17 February 2016, email: [email protected]

Download Full-text

254 Impact of sacubitril/valsartan on implantable defibrillator eligibility in heart failure: a real-world experience

European Heart Journal Supplements ◽

10.1093/eurheartj/suab139.014 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Luca Monzo ◽

Ilaria Ferrari ◽

Carlo Gaudio ◽

Francesco Cicogna ◽

Claudia Tota ◽

...

Keyword(s):

Heart Failure ◽

Primary Prevention ◽

Ejection Fraction ◽

Nyha Class ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Reverse Remodelling ◽

The Impact

Abstract Aims Current guidelines recommend an implantable cardiac defibrillator (ICD) in patients with symptomatic heart failure and reduced ejection fraction [HFrEF; left ventricular ejection fraction (LVEF) ≤35%] despite ≥3 months of optimal medical therapy. Recent observations demonstrated that sacubitril/valsartan induces beneficial reverse cardiac remodelling in eligible HFrEF patients. Given the pivotal role of LVEF in the selection of ICD candidates, we sought to assess the impact of sacubitril/valsartan on ICD eligibility and its predictors in HFrEF patients. Methods and results We retrospectively evaluated 48 chronic HFrEF patients receiving sacubitril/valsartan and previously implanted with an ICD in primary prevention. We assumed that ICD was no longer necessary if LVEF improved >35% (or > 30% in asymptomatics) at follow-up. Over a median follow-up of 11 months, sacubitril/valsartan induced a significant drop in LV end-systolic volume (−16.7 ml/m2, P = 0.023) and diameter (−6.8 mm, P = 0.022), resulting in a significant increase in LVEF (+3.9%, P < 0.001). As a consequence, 40% of previously implanted patients resulted no more eligible for ICD at follow-up. NYHA class improved in the 50% of population. A dose-dependent effect was noted, with higher doses associated to more reverse remodelling. Among patients deemed no more eligible for ICD, lower NYHA class [odds ratio (OR): 3.73 (95% CI: 1.05–13.24), P = 0.041], better LVEF [OR: 1.23 (95% CI: 1.01–1.48), P = 0.032], and the treatment with the intermediate or high dose of sacubitril/valsartan [OR: 5.60 (1.15–27.1), P = 0.032] were the most important predictors of status change. Conclusions In symptomatic HFrEF patients, sacubitril/valsartan induced beneficial cardiac reverse remodelling and improved NYHA class. These effects resulted in a significant reduction of patients deemed eligible for ICD in primary prevention.

Download Full-text

Trajectories of Left Ventricular Ejection Fraction After Acute Decompensation for Systolic Heart Failure: Concomitant Echocardiographic and Systemic Changes, Predictors, and Impact on Clinical Outcomes

Journal of the American Heart Association ◽

10.1161/jaha.120.017822 ◽

2021 ◽

Vol 10 (3) ◽

Author(s):

Judith Albert ◽

Susanne Lezius ◽

Stefan Störk ◽

Caroline Morbach ◽

Gülmisal Güder ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Ventricular Ejection Fraction ◽

Cardiac Decompensation ◽

Patients With Heart Failure

Background Prospective longitudinal follow‐up of left ventricular ejection fraction (LVEF) trajectories after acute cardiac decompensation of heart failure is lacking. We investigated changes in LVEF and covariates at 6‐months' follow‐up in patients with a predischarge LVEF ≤40%, and determined predictors and prognostic implications of LVEF changes through 18‐months' follow‐up. Methods and Results Interdisciplinary Network Heart Failure program participants (n=633) were categorized into subgroups based on LVEF at 6‐months' follow‐up: normalized LVEF (>50%; heart failure with normalized ejection fraction, n=147); midrange LVEF (41%–50%; heart failure with midrange ejection fraction, n=195), or persistently reduced LVEF (≤40%; heart failure with persistently reduced LVEF , n=291). All received guideline‐directed medical therapies. At 6‐months' follow‐up, compared with patients with heart failure with persistently reduced LVEF, heart failure with normalized LVEF or heart failure with midrange LVEF subgroups showed greater reductions in LV end‐diastolic/end‐systolic diameters (both P <0.001), and left atrial systolic diameter ( P =0.002), more increased septal/posterior end‐diastolic wall‐thickness (both P <0.001), and significantly greater improvement in diastolic function, biomarkers, symptoms, and health status. Heart failure duration <1 year, female sex, higher predischarge blood pressure, and baseline LVEF were independent predictors of LVEF improvement. Mortality and event‐free survival rates were lower in patients with heart failure with normalized LVEF ( P =0.002). Overall, LVEF increased further at 18‐months' follow‐up ( P <0.001), while LV end‐diastolic diameter decreased ( P =0.048). However, LVEF worsened ( P =0.002) and LV end‐diastolic diameter increased ( P =0.047) in patients with heart failure with normalized LVEF hospitalized between 6‐months' follow‐up and 18‐months' follow‐up. Conclusions Six‐month survivors of acute cardiac decompensation for systolic heart failure showed variable LVEF trajectories, with >50% showing improvements by ≥1 LVEF category. LVEF changes correlated with various parameters, suggesting multilevel reverse remodeling, were predictable from several baseline characteristics, and were associated with clinical outcomes at 18‐months' follow‐up. Repeat hospitalizations were associated with attenuation of reverse remodeling. Registration URL: https://www.controlled‐trials.com ; Unique identifier: ISRCTN23325295.

Download Full-text

Sex-Specific Prognostic Implications in Dilated Cardiomyopathy After Left Ventricular Reverse Remodeling

Journal of Clinical Medicine ◽

10.3390/jcm9082426 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2426 ◽

Cited By ~ 1

Author(s):

Antonio Cannata ◽

Paolo Manca ◽

Vincenzo Nuzzi ◽

Caterina Gregorio ◽

Jessica Artico ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Ventricular Assist ◽

Ventricular Ejection Fraction ◽

Left Ventricular Reverse Remodeling ◽

Significant Difference

Background. Women affected by Dilated Cardiomyopathy (DCM) experience better outcomes compared to men. Whether a more pronounced Left Ventricular Reverse Remodelling (LVRR) might explain this is still unknown. Aim. We investigated the relationship between LVRR and sex and its long-term outcomes. Methods. A cohort of 605 DCM patients with available follow-up data was consecutively enrolled. LVRR was defined, at 24-month follow-up evaluation, as an increase in left ventricular ejection fraction (LVEF) ≥ 10% or a LVEF > 50% and a decrease ≥ 10% in indexed left ventricular end-diastolic diameter (LVEDDi) or an LVEDDi ≤ 33 mm/m2. Outcome measures were a composite of all-cause mortality/heart transplantation (HTx) or ventricular assist device (VAD) and a composite of Sudden Cardiac Death (SCD) or Major Ventricular Arrhythmias (MVA). Results. 181 patients (30%) experienced LVRR. The cumulative incidence of LVRR at 24-months evaluation was comparable between sexes (33% vs. 29%; p = 0.26). During a median follow-up of 149 months, women experiencing LVRR had the lowest rate of main outcome measure (global p = 0.03) with a 71% relative risk reduction compared to men with LVRR, without significant difference between women without LVRR and males. A trend towards the same results was found regarding SCD/MVA (global p = 0.06). Applying a multi-state model, male sex emerged as an independent adverse prognostic factor even after LVRR completion. Conclusions. Although the rate of LVRR was comparable between sexes, females experiencing LVRR showed the best outcomes in the long term follow up compared to males and females without LVRR. Further studies are advocated to explain this difference in outcomes between sexes.

Download Full-text

Does the lack of left ventricular reverse remodeling always mean non - response to cardiac resynchronization therapy?

Terapevticheskii arkhiv ◽

10.26442/00403660.2019.12.000102 ◽

2019 ◽

Vol 91 (12) ◽

pp. 10-15

Author(s):

V A Kuznetsov ◽

A M Soldatova ◽

T N Enina ◽

D V Krinochkin ◽

S M Dyachkov

Keyword(s):

Cardiac Resynchronization Therapy ◽

Left Ventricular ◽

Functional Class ◽

Cardiac Resynchronization ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Resynchronization Therapy ◽

Ventricular Ejection Fraction ◽

Left Ventricular Reverse Remodeling ◽

Functional Features

Aim. To evaluate clinical, morphological, functional features and mortality level in patients with different value of left ventricular reverse remodeling after cardiac resynchronization therapy (CRT). Materials and methods. The study enrolled 112 patients (mean age 54.6±9.9 years, 83.5% men) with left ventricular ejection fraction (LVEF) І35%, NYHA functional class II-IV. We enrolled patients with QRS width >120 ms or QRS

Download Full-text