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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
Independent predictors of mortality in patients with advanced heart failure treated by cardiac resynchronization
Jens Kreuz1, Fritz Horlbeck, Markus Linhart
1Department of Medicine-Cardiology, University of Bonn, Freud-Str 25, 53105 Bonn, Germany. jens.kreuz@ukb.uni-bonn.de
Insights
This study identified key mortality predictors in advanced heart failure patients receiving cardiac resynchronization therapy with a defibrillator (CRT-D). Impaired kidney function, appropriate ICD therapy, and lack of beta-blocker use were significant risk factors.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Advanced heart failure patients often receive cardiac resynchronization therapy with an implantable cardioverter defibrillator (CRT-D).
- Identifying mortality risk factors in this population is crucial for optimizing treatment and patient outcomes.
Purpose of the Study:
- To identify independent risk factors for mortality in patients treated with CRT-D for advanced heart failure.
Main Methods:
- Retrospective analysis of 239 consecutive patients with advanced heart failure undergoing CRT-D implantation between 2001 and 2010.
- Median follow-up of 43 months, analyzing mortality predictors including baseline kidney function, ICD therapy, and medication use.
Main Results:
- Mortality was predicted by impaired baseline kidney function (HR 1.98), appropriate ICD therapy (HR 2.1), lack of beta-blocker therapy (HR 2.3), and amiodarone use (HR 2).
- 25% of patients (59 out of 239) died during the follow-up period.
Conclusions:
- Beta-blocker therapy shows a survival benefit in long-term CRT-D patients.
- Impaired renal function and appropriate ICD therapies are significant prognostic markers in CRT-D patients.
- Intensified follow-up and treatment adjustments are recommended when these prognostic markers are identified.
Aims:
The current study includes all consecutive patients with advanced heart failure and cardiac resynchronization therapy (CRT) with an implantable cardioverter defibrillator (ICD) over a 10-year period in a tertiary referral centre. It aims at identifying independent risk factors for mortality during CRT-defibrillator (CRT-D) treatment.
Methods And Results:
This study includes 239 consecutive patients who had undergone implantation of a CRT-D system (ejection fraction 25.9 ± 8%; 139 patients with ischaemic, 100 patients with non-ischaemic cardiomyopathy). Enrolment took place between 2001 and 2010, resulting in a median follow-up of 43 ± 30 months. During follow-up, 59 patients (25%) died. An impaired baseline kidney function [hazard ratio (HR) 1.98; 95% confidence interval (CI) 1.7-3; P< 0.0001], appropriate ICD therapy during follow-up (HR 2.1; CI 1.1-3.4; P= 0.001), lack of beta-blocker therapy (HR 2.3; CI 1.6-3.8; P= 0.004), and intake of amiodarone (HR 2; CI 1.8-4.1; P< 0.0001) were identified as predictors of overall mortality.
Conclusion:
This study demonstrates the benefit of beta-blocker therapy also in patients on long-term CRT-D treatment. It confirms the prognostic significance of impaired renal function and the occurrence of appropriate ICD therapies also in CRT-D patients. It argues for an intensified follow-up regimen and adjustment of heart failure treatment whenever these prognostic markers are identified in a patient treated with CRT-D.
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