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To determine whether reverse left ventricular (LV) remodelling relates to long-term outcome, major adverse cardiovascular events (MACE), mode of death, and symptomatic response after cardiac resynchronization therapy (CRT).Three hundred and twenty-two patients with heart failure (HF) [age 69.2 ± 10.7years (mean ± standard deviation)] underwent a clinical assessment and echocardiography before and at a maximum of 9.1 years (median: 36.2 months) after CRT device implantation. Left ventricular reverse remodelling (≥15% reduction in LV end-systolic volume) predicted survival from cardiovascular death (HR: 0.57, P = 0.0066), death from any cause (HR: 0.59, P = 0.0064), death from any cause/hospitalizations for MACE (HR: 0.67, P = 0.0158), and death from pump failure (HR: 0.45, P = 0.0024), independent of beta-blocker use, HF aetiology, gender, baseline NYHA class, and atrial rhythm. Left ventricular reverse remodelling did not predict sudden cardiac death. At 1 year, the symptomatic response rate (improvement by ≥1 NYHA classes or ≥25% increase in walking distance) was 86% in survivors and 76% in non-survivors (P = NS). Left ventricular reverse remodelling did not predict symptomatic response and the symptomatic response did not predict clinical outcome.Left ventricular reverse remodelling is an independent predictor of clinical outcome for up to 5 years after CRT device implantation. Pump failure, rather than sudden cardiac death, is primarily responsible for this association. Left ventricular reverse remodelling, however, does not predict a symptomatic response. There is discordance between the symptomatic response to and the survival benefit of CRT.