Predictors of spontaneous reverse remodeling in mild heart failure patients with left ventricular dysfunction
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Predictors of spontaneous reverse remodeling in mild heart failure patients with left ventricular dysfunction. / Brenyo, Andrew; Barsheshet, Alon; Kutyifa, Valentina; Ruwald, Anne-Christine; Rao, Mohan; Zareba, Wojciech; Pouleur, Anne-Catherine; Knappe, Dorit; Solomon, Scott D; McNitt, Scott; Huang, David T; Moss, Arthur J; Goldenberg, Ilan.
In: CIRC-HEART FAIL, Vol. 7, No. 4, 07.2014, p. 565-572.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Predictors of spontaneous reverse remodeling in mild heart failure patients with left ventricular dysfunction
AU - Brenyo, Andrew
AU - Barsheshet, Alon
AU - Kutyifa, Valentina
AU - Ruwald, Anne-Christine
AU - Rao, Mohan
AU - Zareba, Wojciech
AU - Pouleur, Anne-Catherine
AU - Knappe, Dorit
AU - Solomon, Scott D
AU - McNitt, Scott
AU - Huang, David T
AU - Moss, Arthur J
AU - Goldenberg, Ilan
N1 - © 2014 American Heart Association, Inc.
PY - 2014/7
Y1 - 2014/7
N2 - BACKGROUND: There are limited data regarding factors associated with spontaneous left ventricular reverse remodeling (S-LVRR) among mildly symptomatic heart failure (HF) patients and its prognostic implications on clinical outcomes.METHODS AND RESULTS: Best subsets logistic regression analysis was used to identify factors associated with S-LVRR (defined as ≥15% reduction in left ventricular end-systolic volume at 1-year of follow-up) among 612 patients treated with internal cardioverter defibrillator-only therapy in Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) and to create a score for the prediction of S-LVRR. Cox proportional hazards regression modeling was used to assess the clinical outcome of all internal cardioverter defibrillator-only patients (n=714) with a high S-LVRR score. S-LVRR occurred in 25% of internal cardioverter defibrillator-only patients. Predictors of S-LVRR included systolic blood pressure≥140 mm Hg, serum creatinine<1.0 mg/dL, QRS 130 to 160 ms, and nonischemic cardiomyopathy. Multivariate analysis showed that each 1-point increment in S-LVRR score (range, 0-7) was associated with an 11% (P=0.019) reduction in the risk of HF or death. Treatment with cardiac resynchronization therapy was associated with a significant reduction in the risk of HF or death only among internal cardioverter defibrillator-treated patients with a low (Q1-3) S-LVRR score (hazard ratio=0.55; P<0.001), but not among those with a higher (Q4) score (hazard ratio=1.06; P=0.72).CONCLUSIONS: Our data suggest that approximately one quarter of mild HF patients eligible for biventricular pacing experience S-LVRR. Combined assessment of clinical factors associated with S-LVRR can be used to identify mild HF patients with a low risk for clinical events without cardiac resynchronization therapy intervention.CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.
AB - BACKGROUND: There are limited data regarding factors associated with spontaneous left ventricular reverse remodeling (S-LVRR) among mildly symptomatic heart failure (HF) patients and its prognostic implications on clinical outcomes.METHODS AND RESULTS: Best subsets logistic regression analysis was used to identify factors associated with S-LVRR (defined as ≥15% reduction in left ventricular end-systolic volume at 1-year of follow-up) among 612 patients treated with internal cardioverter defibrillator-only therapy in Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) and to create a score for the prediction of S-LVRR. Cox proportional hazards regression modeling was used to assess the clinical outcome of all internal cardioverter defibrillator-only patients (n=714) with a high S-LVRR score. S-LVRR occurred in 25% of internal cardioverter defibrillator-only patients. Predictors of S-LVRR included systolic blood pressure≥140 mm Hg, serum creatinine<1.0 mg/dL, QRS 130 to 160 ms, and nonischemic cardiomyopathy. Multivariate analysis showed that each 1-point increment in S-LVRR score (range, 0-7) was associated with an 11% (P=0.019) reduction in the risk of HF or death. Treatment with cardiac resynchronization therapy was associated with a significant reduction in the risk of HF or death only among internal cardioverter defibrillator-treated patients with a low (Q1-3) S-LVRR score (hazard ratio=0.55; P<0.001), but not among those with a higher (Q4) score (hazard ratio=1.06; P=0.72).CONCLUSIONS: Our data suggest that approximately one quarter of mild HF patients eligible for biventricular pacing experience S-LVRR. Combined assessment of clinical factors associated with S-LVRR can be used to identify mild HF patients with a low risk for clinical events without cardiac resynchronization therapy intervention.CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.
KW - Aged
KW - Canada/epidemiology
KW - Defibrillators, Implantable
KW - Echocardiography
KW - Europe/epidemiology
KW - Female
KW - Heart Failure/mortality
KW - Heart Ventricles/diagnostic imaging
KW - Humans
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Risk Factors
KW - Stroke Volume/physiology
KW - Survival Rate/trends
KW - United States/epidemiology
KW - Ventricular Dysfunction, Left/mortality
KW - Ventricular Remodeling
U2 - 10.1161/CIRCHEARTFAILURE.113.000929
DO - 10.1161/CIRCHEARTFAILURE.113.000929
M3 - SCORING: Journal article
C2 - 24786217
VL - 7
SP - 565
EP - 572
JO - CIRC-HEART FAIL
JF - CIRC-HEART FAIL
SN - 1941-3289
IS - 4
ER -
