Myocardial recovery after cardiac resynchronization therapy in left bundle branch block‐associated idiopathic nonischemic cardiomyopathy: A NEOLITH II substudy. Issue 2 (28th September 2018)

• Record Type: Journal Article
• Authors: Wang, Norman C.; Hussain, Aliza; Adelstein, Evan C.; Althouse, Andrew D.; Sharbaugh, Michael S.; Jain, Sandeep K.; Shalaby, Alaa A.; Voigt, Andrew H.; Saba, Samir
• Is Part Of: Annals of noninvasive electrocardiology. Volume 24:Issue 2(2019:Mar.)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-09-28
• Subjects: cardiac resynchronization therapy -- left bundle branch block -- left ventricular ejection fraction -- myocardial recovery -- nonischemic cardiomyopathy -- outcomes; Electrocardiography -- Periodicals; Arrhythmia -- Periodicals; 616.1207547
• DOI: 10.1111/anec.12603
• Languages: English
• ISSNs: 1082-720X

Abstract

Abstract: Background: Baseline predictors of myocardial recovery after cardiac resynchronization therapy (CRT) in left bundle branch block (LBBB)‐associated idiopathic nonischemic cardiomyopathy (NICM) are unknown. Methods: A retrospective study included subjects with idiopathic NICM, left ventricular ejection fraction (LVEF) ≤35%, and LBBB. Myocardial recovery was defined as post‐CRT LVEF ≥50%. Logistic regression analyses described associations between baseline characteristics and myocardial recovery. Cox regression analyses estimated the hazard ratio (HR) between myocardial recovery status and adverse clinical events. Results: In 105 subjects (mean age 61 years, 44% male, mean initial LVEF 22.6% ± 6.6%, 81% New York Heart Association class III, and 98% CRT‐defibrillators), myocardial recovery after CRT was observed in 56 (54%) subjects. Hypertension, heart rate, and serum blood urea nitrogen (BUN) had negative associations with myocardial recovery in univariable analyses. These associations persisted in multivariable analysis: hypertension (odds ratio (OR), 0.40; 95% confidence interval (CI), 0.17–0.95; p = 0.04), heart rate (OR per 10 bpm, 0.69; 95% CI, 0.48–0.997; p = 0.048), and serum BUN (OR per 1 mg/dl, 0.94; 95% CI, 0.88–0.99; p = 0.04). Subjects with post‐CRT LVEF ≥50%, when compared to <50%, had lower risk for adverse clinical events (heart failure hospitalization, appropriate implantable cardioverter‐defibrillator shock, appropriate anti‐tachycardia pacing therapy, ventricular assist device implantation, heart transplantation, and death) over a median follow‐up of 75.9 months (HR, 0.38; 95% CI, 0.16–0.88; p = 0.02). Conclusion: In LBBB‐associated idiopathic NICM, myocardial recovery after CRT was associated with absence of hypertension, lower heart rate, and lower serum BUN. Those with myocardial recovery had fewer adverse clinical events.