IMPACT OF BASELINE LV VOLUME ON LV REVERSE REMODELING AFTER CRT

Background: Left ventricular (LV) dilatation may limit LV reverse remodeling (LVRR) after cardiac resynchronization therapy (CRT). The impact of baseline LV volumes on LVRR after CRT implantation and subsequent outcomes is unknown. Methods: Patients from an ongoing CRT-registry were stratified into quintiles according to baseline LV end-diastolic volume indexed for body surface area (LVEDVi). LVRR was defined as ≥15% reduction in LV end-systolic volume at 6 months follow-up after CRT. Independent associates of LV remodeling were assessed and long-term mortality rates were compared between patients with and without LVRR (across the different LVEDVi-quintiles). Results: 1,121 patients were included (mean age 65±10 years, 77% males). Patients with larger baseline LVEDVi had worse survival after CRT implantation (Log-Rank test p=0.001). Cumulative 10-year survival was significantly better in patients with versus without LVRR (53.9% versus 37.3%; p<0.001). Significant LV reverse remodeling was observed in all LVEDVi-quintiles. In addition, patients with LV reverse remodeling had superior survival compared to patients without LVRR, regardless baseline LVEDVi-quintile (Figure 1; all Log-Rank tests p<0.05). Conclusion: Many patients with larger baseline LV volumes still show significant LVRR after CRT; and had superior survival (regardless of baseline LV volumes) compared to patients without LVRR. Therefore, CRT should not be denied to HF patients on the basis of severe LV dilatation.