Continued Remodeling Despite Cardiac Resynchronization Therapy in Mildly Symptomatic Heart Failure Identifies Subjects at Increased Mortality: Long Term Follow-Up Results From REVERSE

BACKGROUND: Adverse remodeling with left ventricular dilation is associated with increased mortality in heart failure (HF). Multiple drug and device therapies are directed at reversing the remodeling process. In this regard, Cardiac Resynchronization Therapy (CRT) is one of the most effective therapies for reverse remodeling. However, little is known regarding long term prognosis when continued LV dilation occurs despite CRT. METHODS: The REVERSE study randomized 419 patients (pts) with NYHA I/II HF to receive CRT with a prospectively planned 5-year long-term follow-up phase with core lab adjudicated endpoints. Of these pts, 353 had paired left ventricular end systolic volume index (LVESVi) measurements at baseline and 6 months post-implant. Pts were divided into two groups based on LVESVi change to examine their mortality rates: LVESVi increased or decreased after 6 months of CRT. RESULTS: Pts in whom LVESVi increased with CRT (n=89) had 29.8% mortality 4.5 years later. This was significantly higher than the 8.0% mortality rate among pts (n=264) with a reduction of LVESVi (Figure, p CONCLUSIONS: Continued adverse remodeling despite CRT was observed in 25% of subjects, and this was associated with tripling of long term mortality. Simple clinical factors can help identify these high risk pts in whom alternative therapies should be considered.