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Long‐term outcomes of cardiac resynchronization therapy by left ventricular ejection fraction
Author(s) -
Kutyifa Valentina,
Vermilye Katherine,
Solomon Scott D.,
McNitt Scott,
Moss Arthur J.,
Daimee Usama A.
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1357
Subject(s) - medicine , ejection fraction , cardiac resynchronization therapy , cardiology , hazard ratio , heart failure , implantable cardioverter defibrillator , left bundle branch block , confidence interval , proportional hazards model
Aims Despite our prior report suggesting heart failure (HF) risk reduction from cardiac resynchronization therapy with defibrillator (CRT‐D) in mild HF patients with higher left ventricular ejection fraction (LVEF > 30%), data on mortality benefit in this cohort are lacking. We aimed to assess long‐term mortality benefit from CRT‐D in mild HF patients by LVEF > 30%. Methods and results Among 1274 patients with mild HF and left bundle branch block enrolled in MADIT‐CRT, we analysed long‐term effects of CRT‐D vs. implantable cardioverter defibrillator (ICD) therapy only, and reverse remodelling to CRT‐D (left ventricular end‐systolic volume percent change ≥ median at 1 year), on all‐cause mortality and HF for the LVEF ≤ 30% and LVEF > 30 subgroups using Kaplan–Meier and Cox analyses. During long‐term follow‐up, CRT‐D vs. ICD was associated with reduction in all‐cause mortality in both patients with LVEF > 30% and LVEF ≤ 30% [hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.25–0.85, P = 0.036 vs. HR 0.69, 95% CI 0.49–0.98, P = 0.013, interaction P = 0.261]. The efficacy of CRT‐D vs. ICD only to reduce HF was similar in those with LVEF above and below 30% (HR 0.36, 95% CI 0.35–0.61, P < 0.001 vs. HR 0.46, 95% CI 0.35–0.61, P < 0.001; interaction P = 0.342). Patients with CRT‐D‐induced reverse remodelling had significant mortality reduction when compared to ICD, with either LVEF > 30% or LVEF ≤ 30% (HR 0.17 and 0.39), but no mortality benefit was seen in patients with less reverse remodelling. HF events, however, were reduced in both CRT‐D‐induced high and low reverse remodelling vs. ICD only, in both LVEF subgroups. Conclusions In MADIT‐CRT, left bundle branch block patients with higher LVEF (> 30%) derive long‐term mortality benefit from CRT‐D when exhibiting significant reverse remodelling. Clinical Trial registration: ClinicalTrials.gov ID NCT00180271, NCT01294449, and NCT02060110