Long Term Left Ventricular Reverse Remodeling and Functional Outcome after Cardiac Resynchronization in Advanced Heart Failure

Abstract

Objectives: The purpose of this study was to assess long-term outcomes of cardiac resynchronization therapy (CRT) on left ventricular reverse remodeling and functional recovery in patients with advanced heart failure and to establish predictors for positive response to cardiac resynchronization. Methods: The study population consisted of 48 patients (age 68 ± 8.51 years, 79.55% male). Patients underwent transthoracic echocardiography, electrocardiogram, the 6-minute walk test (6MWT) and NYHA functional class evaluation before biventricular pacemaker implantation and during follow-up. Results: Median follow-up was 21.89 ± 9.21 months. 4 (7.7%) patients died from heart failure. Reverse left ventricular remodeling was observed in 77.08% (N=37) patients. CRT resulted in statistically significant improvement of NYHA functional class (p=0.015) and the increased results of 6MWT (p=0.000). Logistic regression analysis demonstrated lower pulmonary artery systolic pressure (PASP) (OR 1.152, 95% CI 1.026-1.293; p=0.017) and more severe mitral regurgitation (OR 0.11, 95% CI 0.018-0.769; p=0.025) prior to device implantation as significant predictors of positive response to CRT. Poor response cut-off value of PASP ≥ 46 mmHg was established in ROC analyses, with 78% of sensitivity and 62% of specificity. Conclusions: Our study confirmed the reversible cardiac remodeling and improvement in systolic left and right ventricular function and functional condition in advanced heart failure patients treated with CRT. According to our study, lower pulmonary artery pressure and more severe mitral regurgitation prior to device implantation predicted favorable long-term response to CRT.