http://www.theheart.org/web_slides/1145487.do A moderately large, randomized, double-blind, parallel-group trial on Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) evaluating CRT in the mildest forms of HF

1. REVERSE (Resynchronization Reverses
Remodeling in Systolic Left Ventricular
Dysfunction)

2. REVERSE (Resynchronization Reverses Remodeling in
Systolic Left Ventricular Dysfunction)
C Linde (Karolinska Hospital, Stockholm, Sweden)
American College of Cardiology 2008 Scientific Sessions
• A moderately large, randomized, double-blind, parallel-group trial evaluating CRT
in the mildest forms of HF
• Population and treatment:
610 patients in NYHA functional class 1 or 2 with a QRS duration ≥ 120 ms, LVEF
≤40% (mean, 27%), and LV end-diastolic dimension ≥55 mm
Randomized to device implantation with CRT function turned either off or on
• Primary outcome:
Composite of all-cause mortality, heart-failure hospitalizations, CRT activation due
to worsening heart failure, worsened NYHA class, and patient global assessment
CRT=cardiac resynchronization therapy
LV=left ventricular

3. REVERSE: Results
• No difference with respect to the primary end point at one year with CRT on
• In a post hoc analysis, however, more patients improved with CRT on than off
• LV end-systolic and end-diastolic volume indexes fell significantly more with CRT
on (p<0.0001 for both )
Change in primary end point at 12 months, by CRT group
Change in end point CRT off (%) CRT on (%)
Analysis prespecified
Worsened 21 16a
Improved or unchanged 79 84
Analysis not prespecified
Worsened 21 16
Unchanged 39 30
Improved 40 54b
a. p=0.10 vs CRT-off group
b. p=0.004 vs CRT-off group

4. REVERSE: Commentary*
"It is possible that you could avoid an expensive device for a period of time. They
have a relatively short life span, so you'd want to put it off until you have to put it in."
- Dr Bruce D Lindsay
"REVERSE is the first large, randomized, double-blind study to show that CRT in
asymptomatic and mildly symptomatic heart-failure patients on optimal medical
therapy reverses left ventricular remodeling, reduces the risk of heart-failure
hospitalization, and may improve clinical outcome."
- Dr Cecilia Linde
*All comments from REVERSE remodeling outcome supports CRT in mildest heart failure, despite
negative primary end point (http://www.theheart.org/article/854151.do)

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