Association between heart failure aetiology and magnitude of echocardiographic remodelling and outcome of cardiac resynchronization therapy

Marielle Kloosterman, Antonius M. W. van Stipdonk, Iris ter Horst, Michiel Rienstra, Isabelle C. Van Gelder, Marc A. Vos, Frits W. Prinzen, Matthias Meine, Kevin Vernooy, Alexander H. Maass*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Web of Science)

Abstract

Aims Echocardiographic response after cardiac resynchronization therapy (CRT) is often lesser in ischaemic cardiomyopathy (ICM) than non-ischaemic dilated cardiomyopathy (NIDCM) patients. We assessed the association of heart failure aetiology on the amount of reverse remodelling and outcome of CRT. Methods and results Nine hundred twenty-eight CRT patients were retrospectively included. Reverse remodelling and endpoint occurrence (all-cause mortality, heart transplantation, or left ventricular assist device implantation) was assessed. Two response definitions [>= 15% reduction left ventricular end systolic volume (LVESV) and >= 5% improvement left ventricular ejection fraction] and the most accurate cut-off for the amount of reverse remodelling that predicted endpoint freedom were assessed. Mean follow-up was 3.8 +/- 2.4 years. ICM was present in 47%. ICM patients who were older (69 +/- 7 vs. 63 +/- 11), more often men (83% vs. 58%), exhibited less LVESV reduction (13 +/- 31% vs. 23 +/- 32%) and less left ventricular ejection fraction improvement (5 +/- 11% vs. 10 +/- 12%) than NIDCM patients (all P <0.001). Nevertheless, every 1% LVESV reduction was associated with a relative reduction in endpoint occurrence: NIDCM 1.3%, ICM 0.9%, and absolute risk reduction was similar (0.4%). The most accurate cut-off of LVESV reduction that predicted endpoint freedom was 17.1% in NIDCM and 13.2% in ICM. Conclusions ICM patients achieve less reverse remodelling than NIDCM, but the prognostic gain in terms of survival time is the same for every single percentage of reverse remodelling that does occur. The assessment and expected magnitude of reverse remodelling should take this effect of heart failure aetiology into account.

Original languageEnglish
Pages (from-to)645-653
Number of pages9
JournalEsc heart failure
Volume7
Issue number2
DOIs
Publication statusPublished - Apr 2020

Keywords

  • Cardiac resynchronization therapy
  • Echocardiography
  • Clinical response
  • Aetiology
  • ESC GUIDELINES
  • REVASCULARIZATION
  • CARDIOMYOPATHY
  • DEFIBRILLATOR

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