Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation

Abstract

BACKGROUND AND AIMS: Patients with moderate-to-severe chronic kidney disease (CKD) are underrepresented in clinical trials of cardiac resynchronization therapy (CRT)-defibrillation (CRT-D) or CRT-pacing (CRT-P). We sought to determine whether outcomes after CRT-D are better than after CRT-P over a wide spectrum of CKD. METHODS AND RESULTS: Clinical events were quantified in relation to preimplant estimated glomerular filtration rate (eGFR) after CRT-D (n = 410 [39.2%]) or CRT-P (n = 636 [60.8%]) implantation. Over a follow-up period of 3.7 years (median, interquartile range: 2.1-5.7), the eGFR < 60 group (n = 598) had a higher risk of total mortality (adjusted hazard ratio [aHR]: 1.28; P = 0.017), total mortality or heart failure (HF) hospitalization (aHR: 1.32; P = 0.004), total mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.34; P = 0.002), and cardiac mortality (aHR: 1.33; P = 0.036), compared to the eGFR ≥ 60 group (n = 448), after covariate adjustment. In analyses of CRT-D versus CRT-P, CRT-D was associated with a lower risk of total mortality (eGFR ≥ 60 HR: 0.65; P = 0.028; eGFR < 60 HR: 0.64, P = 0.002), total mortality or HF hospitalization (eGFR ≥ 60 aHR: 0.66; P = 0.021; eGFR < 60 aHR: 0.69, P = 0.007), total mortality or hospitalization for MACEs (eGFR ≥ 60 aHR: 0.70; P = 0.039; eGFR < 60 aHR: 0.69, P = 0.005), and cardiac mortality (eGFR ≥ 60 aHR: 0.60; P = 0.026; eGFR < 60 aHR: 0.55; P = 0.003). CONCLUSION: In CRT recipients, moderate CKD is associated with a higher mortality and morbidity compared to normal renal function or mild CKD. Despite less favorable absolute outcomes, patients with moderate CKD had better outcomes after CRT-D than after CRT-P.

Publication DOI: https://doi.org/10.1111/pace.13659
Divisions: College of Health & Life Sciences > Aston Medical School > Translational Medicine Research Group (TMRG)
College of Health & Life Sciences > Aston Medical School
College of Health & Life Sciences
Additional Information: This is the peer reviewed version of the following article: Leyva, F. , Zegard, A. , Taylor, R. , Foley, P. W., Umar, F. , Patel, K. , Panting, J. , Ferro, C. J., Chalil, S. , Marshall, H. and Qiu, T. (2019), Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation. Pacing Clin Electrophysiol. Accepted Author Manuscript, which has been published in final form at https://doi.org/10.1111/pace.13659.  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Uncontrolled Keywords: cardiac resynchronization therapy,chronic kidney disease,heart failure,implantable cardioverter defibrillator,Cardiology and Cardiovascular Medicine
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Related URLs: https://onlinel ... 1111/pace.13659 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2019-06-01
Published Online Date: 2019-03-15
Accepted Date: 2019-03-04
Authors: Leyva, Francisco
Zegard, Abbasin
Taylor, Robin
Foley, Paul W.x.
Umar, Fraz
Patel, Kiran
Panting, Jonathan
Ferro, Charles J.
Chalil, Shajil
Marshall, Howard
Qiu, Tian

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