试验设计：左室功能异常（NYHA心功能分级Ⅰ–Ⅱ级）且宽QRS的患者随机分为心脏再同步化治疗（CRT）组（n= 419）和最佳药物治疗组（n= 191）。

    结果

    ● 病情恶化：CRT组16%，最佳药物治疗组21%（P=0.1）。

    ● 左室收缩末期容积指数：CRT组下降18.4 ml/m2，最佳药物治疗组下降1.3 ml/m2（P<0.0001）。

    ● CRT组心力衰竭住院风险降低（P=0.03）。

    结论

    ● CRT不能延缓轻度心力衰竭患者病情进展。

    ● 与药物治疗相比，CRT改善左室收缩末期容积指数，降低再住院率。

 原始摘要：

Objectives: We sought to determine the effects of cardiac resynchronization therapy (CRT) in New York Heart Association (NYHA) functional class II heart failure (HF) and NYHA functional class I (American College of Cardiology/American Heart Association stage C) patients with previous HF symptoms.

Background: Cardiac resynchronization therapy improves left ventricular (LV) structure and function and clinical outcomes in NYHA functional class III and IV HF with prolonged QRS.

Methods: Six hundred ten patients with NYHA functional class I or II heart failure with a QRS 120 ms and a LV ejection fraction 40% received a CRT device (±defibrillator) and were randomly assigned to active CRT (CRT-ON; n = 419) or control (CRT-OFF; n = 191) for 12 months. The primary end point was the HF clinical composite response， which scores patients as improved， unchanged， or worsened. The prospectively powered secondary end point was LV end-systolic volume index. Hospitalization for worsening HF was evaluated in a prospective secondary analysis of health care use.

Results: The HF clinical composite response end point， which compared only the percent worsened， indicated 16% worsened in CRT-ON compared with 21% in CRT-OFF (p = 0.10). Patients assigned to CRT-ON experienced a greater improvement in LV end-systolic volume index (–18.4 ± 29.5 ml/m2 vs. –1.3 ± 23.4 ml/m2， p < 0.0001) and other measures of LV remodeling. Time-to-first HF hospitalization was significantly delayed in CRT-ON (hazard ratio: 0.47， p = 0.03).

Conclusions: The REVERSE (REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction) trial demonstrates that CRT， in combination with optimal medical therapy (±defibrillator)， reduces the risk for heart failure hospitalization and improves ventricular structure and function in NYHA functional class II and NYHA functional class I (American College of Cardiology/American Heart Association stage C) patients with previous HF symptoms.