Abstract
The role of cardiac resynchronization therapy (CRT) in patients presenting with mild manifestations of heart failure (HF), depressed left ventricular ejection fraction (LV EF), and wide QRS complex, has been addressed in four previous trials: MIRACLE ICD II,1 MADIT-CRT,2 RAFT,3 and REVERSE.4 The consistent observed benefits in reverse cardiac remodelling and reduction of heart failure adverse events have resulted in guideline recommendations for CRT in NYHA Class II patients. The guidelines also recommend further studies to determine whether survival is increased by CRT in patients with mild symptoms. The 5-year analysis of the REsynchronization reVErses Remodeling Systolic left vEntricular (REVERSE) trial, which was designed prospectively for 5-year follow-up to specifically assess the long term benefits of CRT, were recently published in the European Heart Journal.5
Highlights
STUDY DESIGN AND RESULTS The reVErses Remodeling Systolic left vEntricular (REVERSE) trial was a prospective, randomized, double blind, parallel-controlled multinational study designed to determine whether cardiac resynchronization therapy (CRT) limited the progression of heart failure (HF) compared with optimal medical therapy alone
Patients were implanted with a CRT-device with (CRT-D) or without (CRT-P) defibrillator and randomized 2:1 to CRT ON (n 1⁄4 419) or CRT OFF (n 1⁄4 191)
First enrollment occurred in September 2004, and enrollment was completed in September 2006.The final 5-year follow-up was in November 2011.The primary end point was HF clinical composite response, which scores patients as improved, unchanged, or worsened
Summary
All patients were programmed to CRT ON after the randomization period and followed for 5 years from implantation. CRITIQUE The 5-year results of REVERSE confirmed that CRT in mildly symptomatic HF and wide QRS reverses remodeling and is associated with low rates of HF hospitalization and all-cause mortality over the entire follow-up.
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