Melissa A Daubert1, Joseph Massaro2, Lawrence Liao3, Ashish Pershad4, Suresh Mulukutla5, Erik Magnus Ohman3, Jeffrey Popma6, William W O'Neill7, Pamela S Douglas3. 1. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. Electronic address: melissa.daubert@duke.edu. 2. Harvard Clinical Research Institute, Boston, MA; Boston University, Boston, MA. 3. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. 4. Banner Good Samaritan Hospital, Phoenix, AZ. 5. University of Pittsburgh Medical Center, Pittsburgh, PA. 6. Harvard Clinical Research Institute, Boston, MA; Beth Israel Deaconess Hospital, Boston, MA. 7. Henry Ford Hospital, Detroit, MI.
Abstract
BACKGROUND: Therapies that reverse pathologic left ventricular (LV) remodeling are often associated with improved outcomes. The incidence and impact of reverse LV remodeling after high-risk percutaneous coronary intervention (PCI) are unknown. METHODS: The PROTECT II study was a multicenter trial in patients with complex, multivessel coronary artery disease and reduced ejection fraction (EF) that revealed an increase in visual EF after high-risk PCI. Among patients with quantitative echocardiography (LV volumes and biplane EF), we assessed the extent and predictors of reverse LV remodeling, defined as improved systolic function with an absolute increase in EF ≥5% and correlated these findings with clinical events. RESULTS:Quantitative echocardiography was performed in 184 patients at baseline and longest follow-up. Mean EF at baseline was 27.1%. Ninety-three patients (51%) demonstrated reverse LV remodeling with an absolute increase in EF of 13.2% (P < .001). End-systolic volume decreased from 137.7 to 106.6 mL (P = .002). No significant change in EF or end-systolic volume was seen among non-remodelers. Reverse LV remodeling occurred more frequently in patients with more extensive revascularization (odds ratio, 7.52; 95% CI [1.31-43.25]) and was associated with significantly fewer major adverse events (composite of death/myocardial infarction/stroke/transient ischemic attack): 9.7% versus 24.2% (P = .009). There was also a greater reduction in New York Heart Association class III/IV heart failure among reverse LV remodelers (66.7% to 24.0%) than non-remodelers (56.3% to 34.4%), P = .045. CONCLUSIONS:Reverse LV remodeling can occur after high-risk PCI in patients with complex coronary artery disease and reduced EF and is associated with improved clinical outcomes.
RCT Entities:
BACKGROUND: Therapies that reverse pathologic left ventricular (LV) remodeling are often associated with improved outcomes. The incidence and impact of reverse LV remodeling after high-risk percutaneous coronary intervention (PCI) are unknown. METHODS: The PROTECT II study was a multicenter trial in patients with complex, multivessel coronary artery disease and reduced ejection fraction (EF) that revealed an increase in visual EF after high-risk PCI. Among patients with quantitative echocardiography (LV volumes and biplane EF), we assessed the extent and predictors of reverse LV remodeling, defined as improved systolic function with an absolute increase in EF ≥5% and correlated these findings with clinical events. RESULTS: Quantitative echocardiography was performed in 184 patients at baseline and longest follow-up. Mean EF at baseline was 27.1%. Ninety-three patients (51%) demonstrated reverse LV remodeling with an absolute increase in EF of 13.2% (P < .001). End-systolic volume decreased from 137.7 to 106.6 mL (P = .002). No significant change in EF or end-systolic volume was seen among non-remodelers. Reverse LV remodeling occurred more frequently in patients with more extensive revascularization (odds ratio, 7.52; 95% CI [1.31-43.25]) and was associated with significantly fewer major adverse events (composite of death/myocardial infarction/stroke/transient ischemic attack): 9.7% versus 24.2% (P = .009). There was also a greater reduction in New York Heart Association class III/IV heart failure among reverse LV remodelers (66.7% to 24.0%) than non-remodelers (56.3% to 34.4%), P = .045. CONCLUSIONS: Reverse LV remodeling can occur after high-risk PCI in patients with complex coronary artery disease and reduced EF and is associated with improved clinical outcomes.
Authors: Yanan Liu; Shelley L Baumgardt; Juan Fang; Yang Shi; Shigang Qiao; Zeljko J Bosnjak; Jeannette Vásquez-Vivar; Zhengyuan Xia; David C Warltier; Judy R Kersten; Zhi-Dong Ge Journal: Sci Rep Date: 2017-06-08 Impact factor: 4.379
Authors: Mohammad Abumayyaleh; Jonathan Demmer; Carina Krack; Christina Pilsinger; Ibrahim El-Battrawy; Michael Behnes; Assem Aweimer; Andreas Mügge; Siegfried Lang; Ibrahim Akin Journal: Am J Cardiovasc Drugs Date: 2022-03-30 Impact factor: 3.283