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Background <p>In some patients who receive a cardiac resynchronization therapy (CRT) device, the left ventricular ejection fraction (LVEF) does not improve.</p> Methods <p>We analyzed patients enrolled in the REVERSE, MADIT-CRT, and BLOCK-HF trials, restricting the analysis to those who received CRT. Characteristics of patients with or without improved LVEF were compared using two sample <i>t</i>-tests and Pearson’s chi-square tests. Kaplan–Meier survival curves were constructed to display time-to-event data. A log-rank test was used to compare event rates for patients with or without improved LVEF. Mixed effects Cox Proportional-Hazards models adjusting for covariates were used to analyze time to death or heart failure hospitalization (HFH) and time to death.</p> Results <p>Of 1065 included patients, 75% (802) were men, 87% (793) were White, 11% (118) were Black, and 7% (72) were Hispanic. LVEF improved in 910 (85%) patients and did not in 155 (15%). Patients with an improved LVEF were less likely to have ischemic cardiomyopathy (ICM) (54% vs 76%; <i>p</i> = 0.004), more likely to have LBBB (73% vs 53%; <i>p</i> = &lt; 0.001), and had longer QRS duration (159 vs 150 ms; <i>p</i> = &lt; 0.001). In adjusted analyses, improved LVEF was associated with a longer time to HFH or death (HR 0.40; 95% CI 0.26–0.62; <i>p</i> &lt; 0.001) or death alone (HR 0.27; 95% CI 0.15–0.48; <i>p</i> &lt; 0.001).</p> Conclusions <p>Patients with improvement in LVEF post-CRT implantation are less likely to have ICM and more likely to have LBBB and a longer QRS interval. Improvement in LVEF was associated with better outcomes.</p> Graphical Abstract <p></p>

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Clinical phenotypes and outcomes associated with improved left ventricular ejection fraction after biventricular pacing

  • 期刊论文

  • 发表日期：

    2025年4月9日

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  • Sameer A. Kunte,
  • Lurdes Y. T. Inoue,
  • William T. Abraham,
  • John G. F. Cleland,
  • Anne B. Curtis,
  • Daniel J. Friedman,
  • Michael R. Gold,
  • Valentina Kutyifa,
  • Cecilia Linde,
  • Anthony S. Tang,
  • Gillian D. Sanders,
  • Sana M. Al-Khatib

摘要

Background

In some patients who receive a cardiac resynchronization therapy (CRT) device, the left ventricular ejection fraction (LVEF) does not improve.

Methods

We analyzed patients enrolled in the REVERSE, MADIT-CRT, and BLOCK-HF trials, restricting the analysis to those who received CRT. Characteristics of patients with or without improved LVEF were compared using two sample t-tests and Pearson’s chi-square tests. Kaplan–Meier survival curves were constructed to display time-to-event data. A log-rank test was used to compare event rates for patients with or without improved LVEF. Mixed effects Cox Proportional-Hazards models adjusting for covariates were used to analyze time to death or heart failure hospitalization (HFH) and time to death.

Results

Of 1065 included patients, 75% (802) were men, 87% (793) were White, 11% (118) were Black, and 7% (72) were Hispanic. LVEF improved in 910 (85%) patients and did not in 155 (15%). Patients with an improved LVEF were less likely to have ischemic cardiomyopathy (ICM) (54% vs 76%; p = 0.004), more likely to have LBBB (73% vs 53%; p = < 0.001), and had longer QRS duration (159 vs 150 ms; p = < 0.001). In adjusted analyses, improved LVEF was associated with a longer time to HFH or death (HR 0.40; 95% CI 0.26–0.62; p < 0.001) or death alone (HR 0.27; 95% CI 0.15–0.48; p < 0.001).

Conclusions

Patients with improvement in LVEF post-CRT implantation are less likely to have ICM and more likely to have LBBB and a longer QRS interval. Improvement in LVEF was associated with better outcomes.

Graphical Abstract