Author + information
- Received June 21, 2016
- Revision received November 9, 2016
- Accepted November 9, 2016
- Published online February 27, 2017.
- Martin St. John Sutton, MBBSa,∗ (, )
- Cecilia Linde, MD, PhDb,
- Michael R. Gold, MD, PhDc,
- William T. Abraham, MDd,
- Stefano Ghio, MD, PhDe,
- Jeffrey Cerkvenik, MSf,
- Jean-Claude Daubert, MD, PhDg,
- on behalf of the REVERSE Study Group
- aCardiovascular Medicine Division, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
- bDepartment of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- cDivision of Cardiology, Medical University of South Carolina, Charleston, South Carolina
- dDivision of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
- eDepartment of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- fMedtronic plc, Mounds View, Minnesota
- gDepartment of Cardiology, University Hospital, Rennes, France
- ↵∗Address for correspondence:
Dr. Martin St. John Sutton, Cardiovascular Medicine Division, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study sought to determine the effects of abnormal left ventricular (LV) architecture on cardiac remodeling and clinical outcomes in mild heart failure (HF).
Background Cardiac resynchronization therapy (CRT) is an established treatment for HF that improves survival in part by favorably remodeling LV architecture. LV shape is a dynamic component of LV architecture on which contractile function depends.
Methods Transthoracic 2-dimensional echocardiography was used to quantify changes in LV architecture over 5 years of follow-up of patients with mild HF from the REVERSE study. REVERSE was a prospective study of patients with large hearts (LV end-diastolic dimension ≥55 mm), LV ejection fraction <40%, and QRS duration >120 ms randomly assigned to CRT-ON (n = 419) and CRT-OFF (n = 191). CRT-OFF patients were excluded from this analysis. LV dimensions, volumes, mass index, and LV ejection fraction were calculated. LV architecture was assessed using the sphericity index, as follows: (LV end-diastolic volume)/(4/3 × π × r3) × 100%.
Results LV architecture improved over time and demonstrated significant associations between LV shape, age, sex, and echocardiography metrics. Changes in LV architecture were strongly correlated with changes in LV end-systolic volume index and LV end-diastolic volume index (both p < 0.0001). Sphericity index emerged as a predictor of death and HF hospitalization in spite of the low adverse event rate. A decrease in LV end-systolic volume index >15% occurred in more than two-thirds of patients, which indicates considerable reverse remodeling.
Conclusions We demonstrated that change in LV architecture in patients with mild HF with CRT is associated with structural and functional remodeling. Mean LV filling pressure was elevated, and the inability to lower it was an additional predictor of HF hospitalization or death. (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction [REVERSE]; NCT00271154)
The REVERSE study was funded by Medtronic, plc. Dr. St. John Sutton has received consulting fees from Medtronic and BioControl Medical. Dr. Linde has received consulting fees and research grants from Medtronic, St. Jude Medical, and AstraZeneca; and honoraria from Biotronik, Medtronic, St. Jude Medical, Vifor, and Novartis. Dr. Gold has received research grants from Boston Scientific and St. Jude Medical. Dr. Abraham has received consulting fees from Biotronik, Medtronic, and St. Jude Medical. Mr. Cerkvenik is employed by and a shareholder of Medtronic. Dr. Daubert has received consulting fees and research grants from Medtronic. Dr. Ghio has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received June 21, 2016.
- Revision received November 9, 2016.
- Accepted November 9, 2016.
- 2017 American College of Cardiology Foundation