{"id":"6d211758b704","type":"article","url":"https://hartvaat.nl/2016/09/20/volledig-linkszijdig-reverse-remodelling-bij-crt-madit-crt-substudie/","title":"Volledig linkszijdig reverse remodelling bij CRT: MADIT-CRT-substudie","title_en":"Clinical Implications of Complete Left-Sided Reverse Remodeling With Cardiac Resynchronization Therapy: A MADIT-CRT Substudy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.06.051","source_url":"https://doi.org/10.1016/j.jacc.2016.06.051","authors":["Andrew Mathias","Arthur J Moss","Scott McNitt","Wojciech Zareba","Ilan Goldenberg","Scott D Solomon","Valentina Kutyifa"],"significance":6,"published":"2016-09-20","source_date":"2016-09-20","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/cardiale-remodellering/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This MADIT-CRT substudy characterized the clinical implications of complete left-sided reverse remodeling with CRT, showing that super-responders who normalize LV volumes and function have excellent long-term prognosis.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T13:25:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"MADIT-CRT-substudie naar de klinische implicaties van volledig linkszijdig reverse remodelling bij patiënten met CRT. Super-responders met normalisatie van LV-functie hebben een uitstekende prognose.","abstract_original":"BACKGROUND: Clinical implications of complete left-sided reverse remodeling due to cardiac resynchronization therapy with a defibrillator (CRT-D), defined as reduction in both left ventricular end-systolic volume (LVESV) and left atrial volume (LAV), are unknown. OBJECTIVES: This study aimed to evaluate the rate and predictive value of complete left-sided reverse remodeling on heart failure (HF) and death events in CRT-D patients with left bundle branch block (LBBB) enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). METHODS: The study population comprised 533 CRT-D patients with LBBB, 212 (40%) with complete left-sided reverse remodeling (above-median change in both LAV and LVESV), 115 (22%) with discordant reverse remodeling (above-median change in only LAV or LVESV), and 206 (38%) with lesser reverse remodeling (below-median LAV and LVESV change). The primary endpoint was HF or death; secondary endpoints included HF alone and death alone during long-term follow-up. RESULTS: Patients with complete left-sided reverse remodeling had a significantly lower rate of HF or death than those with discordant reverse remodeling or lesser reverse remodeling (p < 0.001). Multivariate Cox proportional hazard models consistently showed a decreased risk for HF and death in patients with complete reverse remodeling compared with discordant reverse remodeling or lesser reverse remodeling (hazard ratio: 0.66 per each group; 95% CI: 0.50 to 0.85; p = 0.002). This finding was similar for HF alone and death alone. CONCLUSIONS: In MADIT-CRT, >20% of CRT-D patients exhibited discordant reverse remodeling in the left ventricle and the left atrium. CRT-D patients with LBBB and complete left-sided reverse remodeling had a significantly lower risk of HF and death, HF alone, and death alone during long-term follow-up than patients with discordant or lesser reverse remodeling. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271)."}