Heart Failure -> Heart Failure Management: -> Clinical Trials D-AB12 - Enhancing Response and Outcomes with CRT (ID 19) Abstract

D-AB12-03 - Reverse Remodeling Is Associated With A Lower Risk Of Heart Failure, Ventricular Arrhythmias, Or Death In Non-lbbb Patients In Madit-crt (ID 764)


Background: While patients with non-LBBB did not benefit from cardiac resynchronization therapy (CRT-D), it is unclear whether non-LBBB patients with significant left ventricular (LV) remodeling would have better outcomes.
Objective: We aimed to assess the relationship between LV reverse remodeling and a novel combined endpoint of heart failure (HF), ICD-treated ventricular tachycardia (VT) or ventricular fibrillation (VF), or death among non-LBBB patients receiving CRT-D.
Methods: We studied 218 patients with non-LBBB, CRT-D, and remodeling data, enrolled in MADIT-CRT, for the combined endpoint of HF, ICD treated VT or, VF, or death after 1-year, by LV reverse remodeling defined as LV end-systolic volume reduction (LVESV)≥25% at 1-year. Predictors of LV reverse remodeling were assessed in a logistic regression model.
Results: There were 124 (57%) non-LBBB patients exhibiting LVESV reduction≥25% at 1-year after CRT-D. The 2-year probability of HF,VT,VF or death in non-LBBB patients with LV reverse remodeling was 28% compared to 45% in patients without reverse remodeling (p=0.007) (Figure). This was consistent with a 45% risk reduction in HF,VT,VF, or death in patients with remodeling vs. no remodeling (HR=0.55, 95% CI=0.35-0.86, p=0.008). Logistic regression analysis identified baseline heart rate≥80 bpm (HR=2.47, p=0.006), and a higher BUN/creatinine ratio≥14.5 (HR=3.19, p=0.029) associated with remodeling.
Conclusion: Non-LBBB patients receiving CRT-D with LV reverse remodeling had a significantly lower rate of HF, VT, VF, or death vs. those without . High baseline heart rate, and high BUN/creatinine ratio identified non-LBBB patients with LV reverse remodeling.