Patients with mild heart failure (HF) whose disease stabilizes with cardiac resynchronization therapy (CRT) experience a longer survival that is similar to that observed in patients whose HF improves with CRT, according to results of an analysis of the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) trial published in JACC: Clinical Electrophysiology.1

This analysis of the randomized REVERSE trial included 406 patients with mild HF. Prespecified criteria, according to the clinical composite score (CCS) and change in left ventricular end-systolic volume index (LVESVi), classified patients as improved, stabilized, or worsened. The investigators compared groups in terms of all-cause mortality at 5 years.

Approximately 56% of patients improved at 1 year whereas 30% had stable disease and 14% had worsened disease. Patients in the stable disease group had a significantly lower 5-year mortality rate compared with patients with worsened disease (10% vs 21%, respectively; P =.01).

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In patients with adequate echocardiograms, the study investigators also found a 73% decrease in the risk for mortality at 5 years among who stabilized or improved vs patients who experienced worsened HF (8% vs 30%, respectively; P <.01).

According to multivariate analysis,1 independent predictors of long-term mortality included LVESVi worsening with CRT at 6 months (hazard ratio [HR], 2.58 [95% CI, 1.35-4.93]; P =.004), baseline LVESVi (HR, 1.14 [95% CI, 1.04-1.24]; P =.004), and sex (HR, 0.11 [95% CI, 0.01-0.81]; P =.030).

A limitation of this study was the inclusion of only patients with mild HF, which may have reduced the generalizability of the results across patients with more advanced disease.

“We need to redefine our current understanding of CRT response to include stability as a favorable outcome for this patient population,” said lead study author Michael R. Gold, MD, PhD, in a statement.2


1. Gold MR, Rickard J, Daubert JC, Zimmerman P, Linde C. Redefining the classifications of response to cardiac resynchronization therapy: results from the REVERSE study. JACC Clin Electrophysiol. Published online February 24, 2021. doi:10.1016/j.jacep.2020.11.010

2. New analysis of REVERSE trial reveals benefits of CRT for more patients with heart failure. Medtronic. March 2, 2021. Accessed March 22, 2021.