European Heart Journal Advance Access published online on May 30, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn221
The magnitude of reverse remodelling irrespective of aetiology predicts outcome of heart failure patients treated with cardiac resynchronization therapy
1 Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USA
2 Department of Cardiology, University of Foggia, Foggia, Italy
3 Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
4 Service of Biometry and Clinical Epidemiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
5 Department of Cardiology, Stanford University, Palo Alto, CA, USA
6 Texas Cardiac Arrhythmia Institute at St David's Medical Center, Austin, TX, USA
Received 20 December 2007; revised 17 April 2008; accepted 6 May 2008.
* Corresponding author. Tel: +1 440 247 0011, Fax: +1 440 247 0011, Email: nataleam{at}roadrunner.com
Aims: We assessed the relationship between cardiac resynchronization therapy (CRT)-induced reverse remodelling and mortality during a long-term follow-up in a prospective observational study.
Methods and results: We analyzed data from a prospective registry including 398 consecutive patients who underwent CRT between September 1998 and September 2007. Left ventricular ejection fraction (LVEF) was assessed before CRT and in the period between 3 and 6 months following implant. All-cause mortality, urgent transplantation and implantation of left ventricular assist device were all considered relevant events. A total of 398 (179 non-ischaemic and 219 ischaemic) patients were analysed. Overall, the increase of LVEF was statistically significant and was computed with 7.0 points (95% CI 5.8–8.3, P < 0.001). Non-ischaemic patients had a larger increase [9.2 points (95% CI 7.0–11.1), P < 0.001] of their LVEF from baseline, when compared with the ischaemic group. The median duration of follow-up was 4.4 years. The cumulative incidence of all events at the end of the 96 months period of follow-up was 55% and it was 34% (95% CI 29–40) at 5 years. At the multivariable analysis of the event-free survival, aetiology lost its predictive value (HR 0.92, P = 0.47), while a change in LVEF 
6 points still significantly decreased the risk of event during the follow-up (HR 0.30, P = 0.001).
Conclusion: Reverse remodelling measured by LVEF after 3 months is a good predictor of long-term outcome. Patients with an increase in LVEF 6 points have an excellent event-free survival approaching 66% at 5 years of follow-up.
Key Words: Cardiac resynchronization therapy • Heart failure • Ejection fraction • Ischaemic and non-ischaemic aetiology
L.B. and A.A. gave an equivalent contribution on the drafting of the manuscript.