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REVERSE: CRT plus optimal medical therapy improved outcomes at 24 months

The 24-month results suggested less worsening in the European cohort.

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The combination of a pacemaker and optimal medical therapy improved the outcomes and ventricular function in patients with HF, results from a study suggested.

Researchers for the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) trial reported the 24-month results from their European cohort at the American College of Cardiology’s 58th Annual Scientific Sessions in Orlando. The one-year results of the study suggested that adding cardiac resynchronization therapy to optimal medical therapy did not influence the primary endpoint.

The researchers enrolled 610 patients with NYHA Class I or II HF into the study and randomly assigned them to receive either cardiac resynchronization therapy plus optimal medical therapy (CRT-ON) or optimal medical therapy alone (CRT-OFF). In the European cohort (n=262), there were 82 patients in the CRT-OFF group and 180 patients in the CRT-ON group. The primary endpoint was a clinical composite response comparing the proportion of patients worsened in the CRT-ON group vs. those in the CRT-OFF group.

The study results revealed a reduction in the percentage of worsening for the clinical composite endpoint in the CRT-ON patients compared with the CRT-OFF patients (34% vs. 19%, P=.01). Although the addition of CRT therapy did not stop the progression of disease over time, the magnitude of worsening over time was lower in the CRT-ON patients compared with the CRT-OFF patients at six months (20% vs. 7%, P=.005), 12 months (22% vs. 11%, P=.02), 18 months (29% vs. 15%, P=.01) and 24 months (34% vs. 19%, P=.01).

“The 24-month results of the European cohort of REVERSE patients show that CRT in asymptomatic and mildly symptomatic HF patients on optimal medical therapy improves clinical outcomes and improves ventricular structure and function,” Jean-Claude Daubert, MD, a cardiologist at Hôpital Pontchaillou in Rennes, France, said in his presentation. “Cardiac resynchronization therapy thus may modify disease progression in mildly symptomatic HF patients with wide QRS complexes.” – by Eric Raible

My observation is a philosophical one. In the trial, I think we really appreciated how time was important. What is also important is that even in the group that improved, in the group with CRT-ON, some got worse and some did not change at all. What we really would like to know is who are the ones we can help, and I am sure we are getting closer to identifying and sorting that out, which would be the best of all possible worlds.

– Albert L. Waldo, MD

Cardiology Today Editorial Board member

For more information:

• Daubert J. Cardiac resynchronization therapy prevents disease progression in NYHA Class I-II heart failure patients: 24-month results from the European cohort of the REVERSE trial. #416. Presented at: American College of Cardiology 58th Annual Scientific Sessions; March 29-31, 2009; Orlando, Fla.