Related Experiment Video
Updated: Jul 5, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Elevated serum creatinine at baseline predicts poor outcome in patients receiving cardiac resynchronization therapy
Alaa Shalaby1, Aiman El-Saed, Andrew Voigt
1Division of Cardiology, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA. alaa.shalaby@med.va.gov
Insights
Baseline serum creatinine levels predict worse outcomes in patients receiving cardiac resynchronization therapy (CRT). Higher creatinine is linked to increased mortality and heart failure hospitalizations, highlighting its importance in CRT patient management.
Area of Science:
- Cardiology
- Nephrology
- Medical Outcomes
Background:
- Renal insufficiency is a known predictor of mortality in heart failure patients.
- The impact of baseline serum creatinine on outcomes in cardiac resynchronization therapy (CRT) recipients requires further investigation.
Purpose of the Study:
- To evaluate the association between baseline serum creatinine and patient outcomes following CRT implantation.
- To determine if serum creatinine is an independent predictor of mortality and heart failure hospitalizations in CRT recipients.
Main Methods:
- Retrospective review of hospital records for 330 CRT recipients from 2003-2005 and 2004.
- Data collected included demographics, NYHA class, ejection fraction, QRS duration, cardiomyopathy etiology, medical history, medications, and serum creatinine.
- Study endpoints were all-cause mortality and a combined endpoint of mortality plus heart failure hospitalization.
Main Results:
- A total of 66 patients (20.0%) died during a mean follow-up of 19.7 months.
- Patients in the highest creatinine tertile (1.4-3.0 mg/dL) had significantly higher rates of death (28.7%) and the combined endpoint (41.6%) compared to lower tertiles.
- Elevated baseline creatinine independently predicted mortality (HR 1.89) and the combined endpoint (HR 1.94) in multivariate analyses. A 0.1 mg/dL increase in creatinine was associated with an 11% increase in mortality risk.
Conclusions:
- Baseline serum creatinine is a significant predictor of worse survival and adverse outcomes in unselected cardiac resynchronization therapy recipients.
- These findings underscore the importance of assessing renal function in heart failure patients undergoing CRT.
- Serum creatinine offers valuable prognostic information for managing CRT patients.
Background:
Renal insufficiency is recognized as a predictor of mortality and poor outcome in heart failure patients. We sought to study the impact of baseline serum creatinine on subsequent outcome in cardiac resynchronization therapy (CRT) recipients.
Methods:
We retrospectively reviewed hospital records of all CRT recipients at Pittsburgh Veterans Affairs (VA) Healthcare System (2003-2005) and University of Pittsburgh Medical Center (2004). We recorded clinical characteristics at the time of implantation including demographics, New York Heart Association (NYHA) functional class, ejection fraction, QRS duration, cardiomyopathy etiology, medical history, medication use, and serum creatinine. Mortality alone and mortality combined with heart failure hospitalization were the study endpoints.
Results:
Out of the 330 patients studied, a total of 66 (20.0%) patients died over a mean follow-up duration of 19.7 +/- 9.0 months (range 1-44). The cohort was studied by three creatinine tertiles (0.6-1.0, 1.1-1.3, 1.4-3.0 mg/dL). Both study endpoints were observed more frequently in patients in the highest creatinine tertile compared to others (28.7% vs 14.0%, P = 0.008 for death and 41.6% vs 21.5%, P = 0.001 for the combined endpoint). High creatinine remained an independent predictor of mortality (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.06-3.39, P = 0.032) and the combined endpoint (HR 1.94, 95% CI 1.20-3.13, P = 0.007) in multivariate adjusted models. Studied as a continuous variable, increase in creatinine level by 0.1 mg/dL was associated with an 11% increase in mortality risk and a 7% increase in the combined endpoint.
Conclusion:
In an unselected cohort of CRT recipients, the baseline creatinine was found to predict worse survival and poor outcome over a modest follow-up duration.
Related Concept Videos
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:25Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Cardiomyopathy II: Dilated Cardiomyopathy