Prognostic value of renal function in patients with cardiac resynchronization therapy
ABSTRACT Renal insufficiency is prevalent in patients with heart failure and indicates poor prognosis. We examine (i) the relationship between left ventricular (LV) reverse remodeling (RR) and renal function and (ii) the prognostic value of renal function in patients receiving cardiac resynchronization therapy (CRT).
The relationship between LV-RR, defined as a 10% reduction in LV end-systolic volume, and renal function was examined in 85 consecutive patients receiving CRT. Echocardiographic assessment and renal function tests were performed before and 3 months after CRT. All-cause mortality and the composite of mortality or heart failure hospitalization between those with preserved or deteriorated renal function at 3 months were assessed by Kaplan Meier analysis.
There was a slight improvement in glomerular filtration rate (GFR) in those with LV-RR (n=44; 51.7+/-20.4 vs. 54.2+/-19.1 ml/min/1.73 m2; p=0.024) while a significant deterioration (n=41; 61.9+/-17 vs. 48.8+/-13.0 ml/min/1.73 m2; p<0.001) was observed in those without LV-RR. The change (Delta) in GFR was significantly correlated with DeltaLV end-systolic/diastolic volumes and DeltaLV ejection fraction. After follow up of 856.4+/-576.8 days, patients with preserved renal function had significant lower all-cause mortality (log rank chi2=4.82, p=0.029) and the composite endpoints (log rank chi2=5.04, p=0.025).
Preservation of renal function was observed in patients with systolic heart failure and renal insufficiency responding to CRT and provided prognostic information. A rapid decline in renal function after CRT was associated with worse clinical outcomes.
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ABSTRACT: Background Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce mortality in patients with heart failure (HF) and left ventricular dysfunction. However, their efficacy in patients with chronic kidney disease (CKD) is controversial.Objective We examined the association between renal dysfunction and clinical outcomes in patients undergoing ICD and CRTD implantation.Methods Data were collected from the Israeli ICD registry. Estimated Glomerular filtration rate (eGFR) at implantation was assessed using the Modification of Diet in Renal Disease (MDRD) formula. Primary outcome was all-cause mortality. Secondary outcomes included the composite endpoints of death or HF and death or ventricular arrhythmias (VT/VF); any hospitalizations; first appropriate and inappropriate ICD therapy.ResultsDuring the study period (7/2010–11/2012), 2,811 patients were implanted with ICD or CRTD. One-year follow-up data were available for 730 ICD patients and 453 CRTD patients. Patients with eGFR<30 ml/min/1.73m2 (n = 54, 4.6%) were older, had a higher prevalence of diabetes, hypertension or ischemic heart disease. eGFR<30 ml/min/1.73m2 was associated with increased mortality risk in ICD (HR 5.4, 95% CI 1.5–19.2), but not in CRTD patients (HR 0.9, 95% CI 0.1–7.5). Renal dysfunction was associated with the composite endpoints of death or HF and death or VT/VF in ICD, but not in CRTD patients. Mean eGFR during follow-up decreased by 8.0 ±4.3 ml/min/1.73m2 in ICD patients (p = 0.06) and by 1.8± 1.3 ml/min/1.73m2 in patients with CRTD (p = 0.2).Conclusion Based on this retrospective analysis, CKD is associated with adverse prognosis after ICD implantation, but not after CRTD implantation. GFR decreased in patients with ICD, but not in CRTD patients.This article is protected by copyright. All rights reserved.Journal of Cardiovascular Electrophysiology 04/2014; 25(9). DOI:10.1111/jce.12442 · 2.88 Impact Factor
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ABSTRACT: Renal insufficiency is present in more than half of patients with heart failure (HF). The causes of renal dysfunction in heart failure are multifactorial: impaired left ventricular (LV) function leads to increases in right atrial pressure and venous congestion while poor forward flow results in a release of neurohormones and natriuretic peptides, perpetuating a vicious cycle of worsening renal function referred to as the "cardiorenal syndrome". This article is protected by copyright. All rights reserved.Journal of Cardiovascular Electrophysiology 07/2014; 25(11). DOI:10.1111/jce.12502 · 2.88 Impact Factor
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ABSTRACT: Objective A low level of serum albumin is common in chronic kidney disease (CKD) patients with heart failure (HF). Cardiac resynchronization therapy (CRT), a novel therapeutic option, improves cardiac performance in patients with severe HF. In addition, CKD has recently been found to be associated with outcomes after CRT; however, the associations of the serum albumin levels with adverse events and the long-term prognosis in CKD patients who have undergone CRT are unknown. In this study, we investigated whether the albumin levels can be used to the predict mortality rate and incidence of cardiovascular events in CKD patients treated with CRT. Methods A retrospective chart review was conducted in 102 consecutive CKD patients receiving a CRT device for the treatment of advanced HF. The long-term outcomes following device implantation were assessed according to the albumin levels. Results During a median follow-up of 2.6 years, 34 patients (33.3%) died and 66 patients (64.7%) experienced cardiovascular events. A Kaplan-Meier survival analysis revealed that the CKD patients with decreased albumin levels exhibited significantly higher rates of all-cause mortality and cardiovascular events, including hospitalization for progressive HF, than the CKD patients without hypoalbuminemia. Importantly, a multivariate Cox regression analysis of confounding factors showed a low serum albumin level to independently predict all-cause death and cardiovascular events. Conclusion Hypoalbuminemia independently predicts cardiac morbidity and mortality in CKD patients receiving CRT. Assessing the albumin levels provides valuable information regarding the long-term prognosis in CKD patients who undergo CRT.Internal Medicine 01/2014; 53(6):555-61. DOI:10.2169/internalmedicine.53.1209 · 0.97 Impact Factor