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Updated: Jun 8, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

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

Relation between renal function and response to cardiac resynchronization therapy in Multicenter Automatic

Ilan Goldenberg1, Arthur J Moss, Scott McNitt

  • 1Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA. Ilan.Goldenberg@heart.rochester.edu

Heart Rhythm
|September 14, 2010
PubMed

Insights

Elevated BUN to SCr ratio in heart failure patients indicates better response to cardiac resynchronization therapy with a defibrillator (CRT-D), suggesting prerenal function impacts CRT effectiveness.

Area of Science:

  • Cardiology
  • Nephrology
  • Biomedical Engineering

Background:

  • Cardiorenal interactions influence outcomes in heart failure (HF) patients.
  • Previous studies did not link cardiorenal interactions to cardiac resynchronization therapy (CRT) response.

Purpose of the Study:

  • To determine if prerenal failure markers can identify HF patients who benefit from CRT.
  • To test the hypothesis that effective circulating blood volume, assessed by renal markers, predicts CRT response.

Main Methods:

  • 1,803 patients in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) were analyzed.
  • Renal function parameters including serum creatinine (SCr), blood urea nitrogen (BUN), and BUN:SCr ratio were assessed.
  • Patients were stratified by median and quartile values of renal parameters to evaluate CRT-D benefit versus defibrillator-only therapy.

Main Results:

  • CRT-D benefit was inversely related to SCr and directly related to BUN levels.
  • Patients with an elevated BUN:SCr ratio (>18 mg/dL) showed a significantly greater reduction in HF or death risk (HR=0.46) compared to those with a low ratio (HR=0.85).
  • A significant trend (P=.005) demonstrated increasing CRT-D benefit with higher BUN:SCr quartiles.

Conclusions:

  • An elevated BUN:SCr ratio in MADIT-CRT patients was associated with significantly greater risk reduction from CRT-D.
  • These findings suggest a link between prerenal function status and patient response to CRT.
  • Prerenal markers may help personalize CRT selection for heart failure patients.
Abstract

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