P693Normalization of left ventricular systolic function after cardiac resynchronization therapy in patients with dilated cardiomyopathy


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Abstract

Introduction and objective: Reverse remodeling after cardiac resynchronization therapy has been related to improved clinical prognosis, but the potential benefits of normalization of left ventricular function are not currently defined. We have performed this study in order to characterize the patients who normalize their systolic left ventricular function and to describe their clinical course.Methods: Echocardiograms were performed before device implantation and at six month follow-up for patients with dilated cardiomyopathy, with a subsequent 36 month clinical follow-up. Patients with coronary artery or valvular disease, baseline atrial fibrillation or pacemaker stimulation were excluded. Normalization of systolic left ventricular function was considered when ejection fraction (EF) was ≥ 55% at echocardiographic follow-up. Heart failure hospitalization and cardiovascular death were considered events.Results: 47 patients with dilated cardiomyopathy were included (64±9 years; 36.9% women), with mean EF 21±6% and basal QRS duration 166±25 ms. Six months later, 10 patients (21%) with EF ≥ 55% were identified. Predictors of normalization of EF were left ventricle end-diastolic volume (OR 0.94; IC 95% 0.92-0.97) and baseline mitral regurgitant orifice area (OR 0.89; IC 95% 0.86-0.93). No relationship was found with basal EF, basal or stimulated QRS wide, degree of dyssynchrony or device programming. In addition, these patients showed, during 36 month follow up, fewer heart failure hospitalizations (0 vs. 32.4%; p = 0.03) and deaths (0 vs. 29.7%; p = 0.04).Conclusions: In patients with dilated cardiomyopathy, normalization of left ventricular function after CRT is determined by end-diastolic volume and basal mitral regurgitation and identifies patients with an excellent prognosis.

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