Reverse Remodeling In Patients Research Articles

Improved Left Ventricular Function and Remodeling After the David V for Significant Aortic Insufficiency

Valve-sparing root replacement is controversial in patients with significant aortic insufficiency (AI) because the aortic valve cusps often require repair, which may potentially jeopardize long-term valve function. The purpose of this study was to evaluate valve function and left ventricular reverse remodeling in patients undergoing valve-sparing root replacement in the setting of significant AI. A review of the Emory Aortic Surgery database between 2004 and 2012 identified 616 aortic root replacements. Of these procedures, 169 were performed for patients with 3+ or greater AI. Fifty-one patients (30%) underwent a David V procedure. Echocardiography was used to evaluate the degree of AI, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter. The mean echocardiographic follow-up was 18 ± 21 months (range, 1 to 89). Patients undergoing valve-sparing root replacement had an increase in ejection fraction (preoperative 51% ± 7% versus postoperative 57% ± 6%, p < 0.01) and a reduction in left ventricular end-diastolic diameter (preoperative 58 ± 8 mm versus postoperative 48 ± 6 mm, p < 0.01) and left ventricular end-systolic diameter (preoperative 40 ± 8 mm versus postoperative 32 ± 6 mm, p < 0.01). During the follow-up period, freedom from greater than 1+ AI was 96%, and freedom from aortic valve replacement was 98%. The addition of cusp repair did not represent a significant risk factor for recurrent postoperative AI (p= 0.21). The David V technique produces significant left ventricular reverse remodeling and improved ventricular function in patients with chronic severe AI. Long-term data and close follow-up will be paramount in evaluating the durability of valve repair in this patient population.

Effects of cardiac resynchronization therapy in patients with inotrope-dependent class IV end-stage heart failure

BackgroundCardiac resynchronization therapy (CRT) has been widely used for the treatment of refractory heart failure (HF). However, the efficacy of CRT is not well established in class IV HF patients on inotropic support. MethodsTwenty-six patients (age 55±18 years, 73% men) with inotrope-dependent HF were reviewed to evaluate the effectiveness of CRT in class IV HF patients on inotropic support. ResultsIntravenous inotropic therapy was administered for 72±56 days before CRT and consisted of dobutamine (n=24; 3.0±1.2μgkg−1min−1), dopamine (n=2; 4.5±2.1μgkg−1min−1), and/or milrinone (n=16; 0.12±0.09μgkg−1min−1). CRT did not produce significant reverse remodeling in eligible patients (left ventricular ejection fraction 23±7% to 25±9%; p=0.23, left ventricular end-diastolic diameter 70±9mm to 68±9mm; p=0.14). After CRT device implantation, 13 (50%) patients experienced 1 or more episodes of ventricular tachyarrhythmia or sudden cardiac death. Twenty (77%) patients survived to hospital discharge with weaning from inotropic support (70±70 days after CRT implantation). The 1-year survival rate was 81%. However, data from long-term follow-up showed that 68% of the study patients who attained survival discharge had an HF hospitalization event within the follow-up period. ConclusionCRT did not result in significant reverse remodeling in patients with inotrope-dependent class IV end-stage HF. However, it contributed to dramatically improve the cardiovascular outcomes at least in the short-term period in some patients.

The RIME trial: Are we closer to the answer of when to repair ischemic mitral regurgitation?

BACKGROUND The development of mitral valve regurgitation as a result of left ventricular remodelling following myocardial infarction carries adverse implications on survival and quality of life (QOL). There is uncertainty whether mitral valve repair at the time of surgical revascularization improves survival and quality of life and enhances left ventricular reverse remodelling in patients with moderate ischemic mitral regurgitation (IMR). The Randomized Ischemic Mitral Evaluation (RIME) trial investigators tried to address this issue by studying whether repairing moderate IMR at the time of surgical revascularization can lead to more favourable outcomes compared with surgical revascularization only. Results of this multicentre, randomized, controlled trial were recently published in Circulation. 1 RIME was conducted in 6 centres in the UK and one in Poland. Out of 172 patients referred for CABG with moderate IMR, the RIME investigators randomized 73 eligible patients to receive either CABG alone (CABG group; n ¼ 39 patients) or CABG with mitral valve repair (Repair group; n ¼ 34 patients) The primary end-point was oxygen consumption at maximal exercise (VO2Max) measured by cardiopulmonary exercise testing, as an objective measure of functional capacity, at one year. The secondary end-points were left ventricular end-systolic volume indexed to body surface area (LVESVI) and mitral regurgitation volume as well as plasma B-type natriuretic peptide (BNP). All measurement were performed before enrollment and at one year postoperatively. Moderate IMR was defined by echocardiographically derived quantitative measures – namely regurgitant orifice area, regurgitant volume and vena contracta width – as per the ACC/AHA/ASE Valvular Heart Disease Guidelines. Patients were considered eligible if they met any of the above criteria whether at rest or during exercise. 2 Patients were excluded if they had ejection fraction ,30%, structural mitral valve disease (including papillary muscle rupture), significant aortic valve disease, previous or active endocarditis, previous cardiac surgery, unstable angina, symptoms of advanced heart failure or cardiogenic shock or significant comorbidities like liver or renal impairment and chronic obstructive airway disease. All CABG procedures utilized the left internal mammary artery to graft the left anterior descending coronary artery All technically graftable, significantly narrowed coronary arteries were addressed. Mitral repair was performed using a complete annuloplasty ring with the aim of achieving a leaflet coaptation length of at least 8mm and no or trace mitral regurgitation at the end of the operation. Both groups received similar number of grafts but the repair group expectedly had longer bypass and cross clamp times compared to the CABG group. The trial met all its end points with high statistical significance at the proposed follow up period of one year. The primary end point of change in peak oxygen consumption (Peak VO2) showed significant improvement at 1 year. The Peak VO2 in the repair group increased by 22% (from 14.8 ^ 3.2 to 18.1 ^ 2.9mL/kg/min) while the CABG group only increased by 5% (from 15.1 ^ 3.3 to

Response to the letter regarding the article, “Late gadolinium enhancement on cardiac magnetic resonance images predicts reverse remodeling in patients with nonischemic cardiomyopathy treated with carvedilol”

We are really grateful that Dr. Sarli and his colleagues [1] are interested in our cardiac magnetic resonance (CMR) imaging study report [2]. To address their concerns on the effect of our statistical method, we reanalyzed our data using the Mann–Whitney U test as they recommended the comparison between the two groups. Overall, the result of the reanalysis was similar to that of our previously-published report.

Letter to editor: Late gadolinium enhancement on cardiac magnetic resonance images predicts reverse remodeling in patients with nonischemic cardiomyopathy treated with carvedilol

We read with great interest the manuscript written by Kida et al. [1]. In that study, Kida et al. investigated the role of late gadolinium enhancement (LGE) on magnetic resonance images (MRI) in predicting left ventricular reverse remodeling in patients with nonischemic cardiomyopathy treated with carvedilol. Thirty one patients with NICM were included and grouped according to LGE on MRI and followed for 6months. They found that absence of LGE on MRI was predictor of improved left ventricular ejection fraction and left ventricular reverse remodeling.

Tenascin-C as Predictor of Left Ventricular Remodeling and Mortality in Patients With Dilated Cardiomyopathy

BackgroundSeveral cardiac biomarkers, especially brain natriuretic peptide (BNP) and N-terminal (NT)-proBNP, have been used as predictors of prognosis and negative remodeling in DCM. In the present study, we aimed to...

Late gadolinium enhancement on cardiac magnetic resonance images predicts reverse remodeling in patients with nonischemic cardiomyopathy treated with carvedilol

Several studies have demonstrated the improvement of left ventricular ejection fraction (LVEF) in heart failure patients after the long-term treatment with beta blockers [ [1] Hori M. Sasayama S. Kitabatake A. et al. Low-dose carvedilol improves left ventricular function and reduces cardiovascular hospitalization in Japanese patients with chronic heart failure: the Multicenter Carvedilol Heart Failure Dose Assessment (MUCHA) trial. Am Heart J. 2004; 147: 324-330 Abstract Full Text Full Text PDF PubMed Scopus (133) Google Scholar ], although, not all patients have similar results. To date, it has not been fully investigated that patients with systolic heart failure respond uniformly to this therapy. Myocardial fibrosis triggers impaired cardiac systolic function and has an association with adverse cardiovascular events [ 2 Wu K.C. Weiss R.G. Thiemann D.R. et al. Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. J Am Coll Cardiol. 2008; 51: 2414-2421 Abstract Full Text Full Text PDF PubMed Scopus (444) Google Scholar , 3 Cho J.R. Park S. Choi B.W. et al. Delayed enhancement magnetic resonance imaging is a significant prognostic factor in patients with non-ischemic cardiomyopathy. Circ J. 2010; 74: 476-483 Crossref PubMed Scopus (25) Google Scholar ]. Nowadays, late gadolinium enhancement (LGE) on cardiac magnetic resonance images (CMR) is widely used to assess myocardial tissue viability [ 4 Schalla S. Bekkers S.C. Dennert R. et al. Replacement and reactive myocardial fibrosis in idiopathic dilated cardiomyopathy: comparison of magnetic resonance imaging with right ventricular biopsy. Eur J Heart Fail. 2010; 12: 227-231 Crossref PubMed Scopus (60) Google Scholar , 5 Park S. Choi B.W. Rim S.J. et al. Delayed hyperenhancement magnetic resonance imaging is useful in predicting functional recovery of nonischemic left ventricular systolic dysfunction. J Card Fail. 2006; 12: 93-99 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. This study was designed to investigate whether myocardial fibrosis determined by LGE on CMR would be useful to assess left ventricular reverse remodeling (LVRR) in patients with nonischemic cardiomyopathy (NICM) treated with beta blockers.

Combining neurohormonal blockade with continuous-flow left ventricular assist device support for myocardial recovery: A single-arm prospective study

Combining mechanical unloading by a continuous-flow left ventricular assist device (CF-LVAD) and neurohormonal blockade with heart failure medications (HFMED) is an underexplored clinical strategy to promote recovery of cardiac function in patients with advanced heart failure (HF). We implemented a clinical protocol to achieve maximal neurohormonal blockade after placement of a CF-LVAD and assessed its utility in an LVAD weaning (6,200 rpm) study. Thirty-four subjects were enrolled after CF-LVAD and were managed with aggressive, bi-weekly up-titration of HFMED. Twenty-one subjects (8 with coronary artery disease, 13 with idiopathic dilated cardiomyopathy) were included in this LVAD weaning investigation. Overall, combined CF-LVAD and HFMED resulted in significant reverse remodeling with a decrease in left atrial volume index (44.7±16.0 to 31.6±12.1 ml/m(2), p < 0.001) and LV internal diastolic diameter (6.7±1.5 to 6.0±1.6 cm, p = 0.003) and an increase in LV ejection fraction (17.4±6.5 to 33.1±16.2%, p < 0.001) during LVAD weaning (6,200 rpm). Five of 21 (24%) subjects demonstrated recovery of biventricular function. Exploratory analysis showed that recovered subjects had shorter duration HF, less myocardial fibrosis and less myocyte hypertrophy, and were supported at higher LVAD speeds. CF-LVAD support in combination with HFMED leads to significant reverse remodeling in patients with advanced HF. Using this approach, one quarter of patients demonstrated complete recovery of cardiac function. Our results suggest that bridge to recovery in the current device era is a clinically meaningful phenomenon and merits further investigation.

QRS narrowing is associated with reverse remodeling in patients with chronic right ventricular pacing upgraded to cardiac resynchronization therapy.

Patients with chronic right ventricular pacing (RVP) upgraded to cardiac resynchronization therapy (CRT) have been excluded from the majority of clinical trials of CRT. Little is known about the predictors of response in this population. We hypothesized that reversal of RVP-induced electrical dyssynchrony (indexed by QRS duration) by CRT would predict a favorable response. The purpose of this study was to identify baseline characteristics associated with response in patients upgraded to CRT from chronic RVP. Consecutive patients presenting for CRT at the Cleveland Clinic between September 30, 2003, and July 8, 2008, with chronic RVP and serial echocardiograms were included in this analysis. RVP was defined as>85% pacing on a pre-CRT device check, previous AV nodal ablation, or complete pacer dependency per chart notes. Response was defined as a reduction in left ventricular end-systolic volume ≥ 15% from baseline. Clinical, ECG, and echocardiographic data were extracted to determine covariates associated with response. One hundred twelve patients met inclusion criteria, of whom 72 (64.3%) met criteria for response over median follow-up of 9.9 months (interquartile range [6.5-14.7]). No significant differences were noted in terms of male gender (68.1% vs 75.0%; P = .52), ischemic cardiomyopathy (55.6% vs 55.0%; P = 1), pre-CRT QRS duration (189.1 ± 20.7 ms vs 185.5 ± 26.8 ms; P = .47), duration of RVP before CRT upgrade (5.8 ± 3.9 years vs 6.2 ± 4.0 years; P = .57), or baseline left ventricular end-systolic volume (160.0 ± 60.7 mL vs 172.8 ± 67.2 mL; P = .32) between responders and nonresponders, respectively. Percent reduction in QRS duration between the right ventricular-paced and first biventricular-paced waveforms was significantly greater in responders compared with nonresponders (14.4% ± 13.2% vs 7.2%± 14.0%; P = .01). In multivariate analysis, percent reduction in QRS narrowing was the lone factor associated with response (odds ratio 0.02 [0.001-0.42]; P = .01). Reversal of electrical dyssynchrony predicts response to CRT in chronically RV-paced patients upgraded to CRT. Traditional factors associated with a favorable response to CRT in de novo implants (female gender, nonischemic cardiomyopathy, and wider baseline QRS duration) are not significantly associated with response in upgraded patients. Duration of RVP before CRT upgrade is not an important determinant of response.

Electrocardiographic QRS Duration Reflects Right Ventricular Remodeling in Patients Undergoing Corrective Surgery for Isolated Tricuspid Regurgitation: A Comparative Study with Cardiac Magnetic Resonance Imaging

The role of electrocardiogram (ECG) is unclear for the longitudinal follow-up of patients who undergo corrective surgery for isolated severe tricuspid regurgitation (TR). This study sought to investigate the usefulness of changes in QRS duration of ECG after TR surgery in predicting right ventricular (RV) reverse remodeling as determined by cardiac magnetic resonance imaging (CMR). We enrolled 30 consecutive TR patients (27 women, aged 57.8 ± 9.6 years) who had undergone prior left-sided valve surgery. A computer-assisted analysis was performed for objective calculation of QRS duration before and after surgery. At a median CMR follow-up of 27.5 months postsurgery, QRS duration was cut by 14.6%, from 110.4 ± 14.6 msec to 96.9 ± 11.9 msec (P < 0.001), while CMR showed a decrease in RV end-diastolic volume index (RV-EDVI) from 179.5 ± 59.7 to 119.1 ± 30.4 mL/m(2) (P < 0.001). QRS duration correlated significantly with RV-EDVI and RV end-systolic volume index (r = 0.65, P < 0.001 and r = 0.53, P < 0.001, respectively), and a percent change in QRS duration was significantly correlated with a percent change in RV-EDVI (r = 0.40, P = 0.03). When significant RV reverse remodeling was defined as a reduction in RV-EDVI ≥20% following TR surgery, the sensitivity and specificity for significant RV reverse remodeling were 75% and 78%, respectively, with a 9% reduction in QRS duration (P = 0.01, area underneath the receiver operator curve [AUC] = 0.81). The extent of changes in postoperative QRS duration can be used as a useful, inexpensive, and simple index reflecting the occurrence of significant RV reverse remodeling in patients undergoing corrective TR surgery.

Usefulness of Left Ventricular End-Systolic Dimension by Echocardiography to Predict Reverse Remodeling in Patients With Newly Diagnosed Severe Left Ventricular Systolic Dysfunction

In many patients with left ventricular (LV) systolic dysfunction, the LV ejection fraction (LVEF)-a surrogate for reverse remodeling-fails to improve despite optimal medical therapy. The early identification of such patients would allow instituting aggressive treatment, including early therapy with implantable cardioverter defibrillators. We sought to establish the predictors of reverse remodeling in patients with LV systolic dysfunction receiving optimal medical therapy. Patients (n = 568) with newly documented LVEF of ≤0.35, who had ≥1 follow-up echocardiogram after ≥3 months, were evaluated. Reverse remodeling was defined as improvement in LVEF to >0.35. The clinical, laboratory, and echocardiographic data were compared between patients with (n = 263) and without (n = 305) reverse remodeling. The mean follow-up was 27 ± 16 months. Patients who demonstrated reverse remodeling had a significantly greater mean follow-up LVEF (0.51 ± 0.09 vs 0.25 ± 0.08; p <0.001). On multivariate analysis, the baseline LV end-systolic diameter index was the strongest predictor of reverse remodeling (odds ratio 5.79; 95% confidence interval 1.82 to 18.46; p <0.001). Other independent predictors of reverse remodeling were female gender (odds ratio 1.88; 95% confidence interval 1.19 to 2.98; p = 0.007), and nonischemic cardiomyopathy (odds ratio 1.65; 95% confidence interval 1.05 to 2.58; p = 0.03). Baseline LVEF was not an independent predictor of reverse remodeling. In conclusion, among patients with newly diagnosed LV systolic dysfunction, the LV end-systolic diameter index, but not the LVEF, at diagnosis, was a strong predictor of reverse remodeling. Patients with a low likelihood of reverse remodeling might benefit from more aggressive heart failure therapy, including the possible early use of implantable cardioverter defibrillators.

The extent of early left ventricular reverse remodelling is related to midterm outcomes after restrictive mitral annuloplasty in patients with non-ischaemic dilated cardiomyopathy and functional mitral regurgitation

Restrictive mitral annuloplasty (RMA) can often improve heart failure symptoms and induce left ventricular (LV) reverse remodelling in patients with non-ischaemic dilated cardiomyopathy (DCM) and functional mitral regurgitation. However, it is unknown whether the observed LV reverse remodelling translates into better outcomes or not. Fifty patients with advanced non-ischaemic DCM (age, 64 ± 10 years, 74% men) underwent RMA and were followed up with a mean of 2 years. Preoperatively, all had 3 to 4+ functional mitral regurgitation (MR), an ejection fraction (EF) of 26 ± 8.6 %, an indexed LV end-systolic volume (LVESVI) of 112 ± 47 ml/m(2). All patients received complete semi-rigid undersized ring annuloplasty. Correlations between early reduction in LVESVI at 1 month after the operation and mid-term clinical outcomes were analysed. There was no 30-day mortality. LVESVI significantly decreased to 96 ± 53 ml/m(2) and LVEF improved to 31 ± 15%. During follow-up, 16 (32%) recurred heart failure, of whom 7 (14%) died. The receiver operating characteristic (ROC) curve found that a reduction in LVESVI >8.3% had a sensitivity of 80% and a specificity of 78% in predicting all adverse events. With this cut-off value, there were 30 (60%) responders to reverse remodelling. Responders had significantly better survival (96.4 versus 68.7%, P = 0.007) and freedom from heart failure rate (85.4 versus 31.8%, P = 0.0003) than non-responders at 3 years. In a 1-year follow-up echocardiographic study, non-responders had shown no significant LV reverse remodelling with greater degree of residual MR than responders. The extent of early LV reverse remodelling is related to mid-term mortality, heart failure events and late reverse remodelling and repair durability after RMA for non-ischaemic DCM.

Relationship between ultrasonic tissue characterization and myocardial deformation for prediction of left ventricular reverse remodelling in non-ischaemic dilated cardiomyopathy

This study was to evaluate the relationship between ultrasonic tissue characterization by integrated backscatter (IBS) and myocardial deformation assessed by two-dimensional speckled tracking (2DS) imaging for prediction of left ventricular (LV) reverse remodelling in patients with non-ischaemic dilated cardiomyopathy (DCM). Forty-five consecutive patients with non-ischaemic DCM were enrolled prospectively. The mean cyclic variation of integrated backscatter (CVIBS) was calculated as the mean of the septal and posterior wall CVIBS. LV global longitudinal, radial, and circumferential peak strain (GLS, GRS, and GCS, respectively) and twist were obtained. LV reverse remodelling was decided with follow-up echocardiography 12 months. The GLS, GRS, and GCS were correlated with the mean CVIBS. The mean CVIBS and GCS were significantly larger in the 24 patients who had LV reverse remodelling than the 21 patients who had no LV reverse remodelling and the GRS tended to be larger; the GLS and twist did not differ between the two groups. The mean CVIBS and GCS were independent predictors of LV reverse remodelling. Myocardial deformation assessed by 2DS was related to myocardial fibrosis assessed by IBS. LV reverse remodelling was predicted by mean CVIBS and GCS in patients with non-ischaemic DCM and GCS assessed by 2DS imaging is a simple method and therefore it can be readily used in clinical practice.

Surgical treatment of tricuspid valve insufficiency promotes early reverse remodeling in patients with axial-flow left ventricular assist devices

The HeartMate II (Thoratec Corp, Pleasanton, Calif) continuous-flow left ventricular assist device has emerged as the standard of care for patients with advanced heart failure. The objective of this study was to assess the safety and early effectiveness of concomitant tricuspid valve procedures in patients undergoing implantation of a HeartMate II device. From February 2007 to April 2010, 83 patients underwent HeartMate II left ventricular assist device implantation. Of these, 37 patients had concomitant tricuspid valve procedures (32 repairs, 5 replacements) for severe tricuspid regurgitation. The effects of a tricuspid valve procedure on tricuspid regurgitation and right ventricular remodeling were assessed comparing echocardiographic findings at baseline and 30 days after left ventricular assist device implantation. Overall survival was also compared. Patients undergoing a concomitant tricuspid valve procedure had more tricuspid regurgitation (vena contracta, 5.6 ± 2.1 mm vs 2.9 ± 2.0 mm; P < .001), worse right ventricular dysfunction (right ventricular end-diastolic area, 33.6 ± 6.2 mm vs 31.6 ± 8.5 mm; P = .05), higher mean right atrial pressure (17.4 ± 7.1 mm Hg vs 14.9 ± 5.1 mm Hg; P = .03), and a higher Kormos score (2.6 ± 2.1 vs 1.2 ± 1.4; P = .0008) preoperatively. One month after surgery, tricuspid regurgitation was worse in patients who underwent left ventricular assist device implantation alone (+18.6%), whereas it improved significantly in patients undergoing a concomitant tricuspid valve procedure (-50.2%) (P = .005). A corresponding significant reduction in right ventricular end-diastolic area (33.6% ± 6.2% vs 30.1% ± 9.7%; P = .03) and a trend toward better right ventricular function (55.5% ± 79.7% vs 35.7% ± 60.5%; P = .28) were noted in patients undergoing a concomitant tricuspid valve procedure. Survival was comparable between the 2 groups. In patients with severe tricuspid regurgitation undergoing left ventricular assist device implantation, a concomitant tricuspid valve procedure effectively reduces tricuspid regurgitation and promotes reverse remodeling of the right ventricle.

P173 CRT-induced left ventricular reverse remodeling in patients with congestive heart failure

P173 CRT-induced left ventricular reverse remodeling in patients with congestive heart failure

P173 Poster CRT-induced left ventricular reverse remodeling in patients with congestive heart failure

P173 Poster CRT-induced left ventricular reverse remodeling in patients with congestive heart failure

Late gadolinium enhancement by cardiac magnetic resonance imaging predicts reverse remodeling in patients with non-ischemic cardiomyopathy receiving β blocker therapy

The aim of this study was to determine the predict factors of the therapeutic response in left ventricular ejection fraction (LVEF) and remodeling in patients with non-ischemic cardiomyopathy who were receiving treatment with b blockers. We hypothesized LGE by CMR imaging predicted therapeutic response in LVEF and remodeling in patients with non-ischemic cardiomyopathy who were receiving treatment with b blockers. Methods This study included 19 heart failure patients (mean age 52 years, 15 men) who had non-ischemic origin confirmed by coronary angiography and underwent LGE by CMR imaging at 1 month after the initiation of b blocker therapy. Of these, 16 patients received Carvedilol 10 mg/day and 3 patients received Metoprolol 4 mg/day at 1 month of the beta blocker therapy. All patients were treated with a standard heart failure regimen of angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). LVEF was measured according to the Simpson’s modified method using echocardiography at 1 and 6 months. Results Of the 19 patients, 11 (58 %) patients had positive LGE images. Overall, LVEF significantly increased (27 ± 8 to 47 ± 11 %, p<0.0001) and BNP significantly decreased (275 ± 281 to 70 ± 92 pg/ml, p<0.0001). The improvement of LVEF significantly differed between the LGE positive (13 ± 8 %) and negative (31 ± 15 %) patients (p=0.004). Conclusions LGE by CMR imaging predicted therapeutic response in LVEF and remodeling in patients with non-ischemic cardiomyopathy treated with b blockers.

The QRS Narrowing Index Predicts Reverse Left Ventricular Remodeling Following Cardiac Resynchronization Therapy

The relationship between QRS narrowing and response to cardiac resynchronization therapy (CRT) has been controversial. We sought to analyze the relationship between QRS narrowing and reverse remodeling in patients undergoing CRT, taking into account potential confounders including pre-CRT QRS duration and underlying QRS morphology. We reviewed pre- and postimplant electrocardiograms and echocardiograms in a cohort of 233 patients undergoing the new implantation of a CRT device between December 2001 and September 2006. For inclusion in the final cohort, patients had New York Heart Association classes II-IV heart failure, left ventricular ejection fraction (LVEF) ≤ 40%, and QRS duration ≥120 ms. Response to CRT was defined as a reduction in left ventricular end-systolic volume (LVESV) of ≥10%. A multivariate model was constructed to determine the relationship between QRS change and response to CRT. Patients with QRS narrowing had significantly greater reductions in left ventricular end-diastolic volume (LVEDV) (mL) (-26.5 ± 52.5 vs -4.8 ± 44.0, P = 0.002) and LVESV (mL) (-34.0 ± 55.5 vs -9.9 ± 45.8, P = 0.002) and improvement in LVEF (%) (8.9 ± 12.8 vs 4.5 ± 9.0, P = 0.007) than patients without narrowing. In univariate analysis, female gender (P = 0.0002), percent QRS narrowing from baseline (P = 0.008), lack of nitrate (P≤0.0001) and antiarrhythmic medication use (P = 0.01), lack of a nonspecific intraventricular conduction delay (=0.02), nonischemic cardiomyopathy (P = 0.003), and lower pre-CRT LVEDV (P = 0.006) and LVESV [P = 0.01]) were associated with responders. In a multivariate model, QRS narrowing, indexed to the baseline QRS duration, remained strongly associated with response (odds ratio 0.08 [0.01-0.56], P = 0.01). After adjusting for potential confounders, QRS narrowing, indexed to baseline QRS duration, is associated with enhanced reverse ventricular remodeling following CRT.

Effects of cardiac resynchronisation therapy on dilated cardiomyopathy with isolated ventricular non-compaction

ObjectiveTo compare the effects of cardiac resynchronisation therapy (CRT) on left ventricular (LV) reverse remodelling in patients with dilated cardiomyopathy (DCM) associated or not with isolated ventricular non-compaction (IVNC).Methods and...

Tricuspid Annular Plane Systolic Excursion and Response to Cardiac Resynchronization Therapy: Results From the REVERSE Trial

Background The aims of this study were to evaluate tricuspid annular plane systolic excursion (TAPSE) as a predictor of left ventricular (LV) reverse remodeling and clinical benefit of cardiac synchronization therapy (CRT) and to evaluate the effect of CRT on TAPSE in patients with mildly symptomatic systolic heart failure as a substudy of the REsyncronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE) trial. Methods and Results Patients (n = 450) were randomized in a 2:1 fashion to CRT ON or CRT OFF and followed for 12 months. End points were reverse LV remodeling defined as a reduction in LV end-systolic volume of ≥20 mL/m 2 by echocardiography and a clinical composite score, defined as freedom from clinical deterioration. TAPSE was an independent predictor of reverse remodeling, OR = 1.08 (95% CI 1.03–1.14) per mm increase and a favorable clinical composite score, OR = 1.08 (95% CI 1.02–1.14). No significant interactions were observed between TAPSE and CRT ON. CRT ON was not associated with a significant effect on TAPSE compared to CRT OFF, −0.8 ± 4.7 vs. 0.3 ± 5 mm, P = .06. Conclusion TAPSE is an independent predictor of clinical response and improved reverse remodeling in patients with mildly symptomatic heart failure. The effect of CRT is not modified by TAPSE in the present population. CRT is not associated with a clinically significant effect on TAPSE.