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European Journal of Heart Failure Advance Access originally published online on March 14, 2009
European Journal of Heart Failure 2009 11(5):480-488; doi:10.1093/eurjhf/hfp034
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Long-term left ventricular reverse remodelling with cardiac resynchronization therapy: results from the CARE-HF trial

Stefano Ghio1,*, Nick Freemantle2, Laura Scelsi1, Alessandra Serio1, Giulia Magrini1, Michele Pasotti1, Aparna Shankar2, John G.F. Cleland3 and Luigi Tavazzi1

1 Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, University Hospital, Piazzale Golgi 1, 27100 Pavia, Italy
2 Division of Primary Care, Public and Occupational Health, University of Birmingham, UK
3 Department of Cardiology, University of Hull, Kingston upon Hull, UK

* Corresponding author. Tel: +39 0382 503 718, Fax: +39 0382 501 884, Email: s.ghio{at}smatteo.pv.it


  Abstract

Aims: The aim of the present study was to assess the long-term effects of cardiac resynchronization therapy (CRT) on the reverse remodelling of the left ventricle (LV).

Methods and results: The effects of CRT compared with controls on LV dimensions and function were assessed at 3, 9, and 18 months and at the end of study (average 29 months) in 735 (90%) patients with adequate echocardiographic examinations, randomized in the CARE-HF trial. Echocardiographic recordings were submitted to a core laboratory to ensure consistent quantitative analysis. LV volume decreased and ejection fraction increased substantially in the CRT group by 3 months and improved further at each assessment when compared with the control group. Effects were less marked in patients with ischaemic heart disease and those with right ventricular dysfunction, but not in patients with a restrictive LV filling pattern. The extent of reverse remodelling at 18 months showed a modest relationship with baseline interventricular mechanical delay (IVMD).

Conclusion: CRT induces sustained LV reverse remodelling with the most marked effects occurring within the first 3–9 months. The extent of remodelling in response to CRT is related to the aetiology of heart failure and, to a lesser extent, to the IVMD.

Key Words: Resynchronization • Heart failure • Echocardiography

Received July 31, 2008; Revised January 28, 2009; Accepted February 6, 2009


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