Response and outcomes of cardiac resynchronization therapy in patients with renal dysfunction

  • Rita Ilhão MoreiraEmail author
  • Pedro Silva Cunha
  • Pedro Rio
  • Manuel Nogueira da Silva
  • Luísa Moura Branco
  • Ana Galrinho
  • Joana Feliciano
  • Rui Soares
  • Rui Cruz Ferreira
  • Mário Martins Oliveira



Renal dysfunction is often associated with chronic heart failure, leading to increased morbi-mortality. However, data regarding these patients after cardiac resynchronization therapy (CRT) is sparse. We sought to evaluate response and long-term mortality in patients with heart failure and renal dysfunction and assess renal improvement after CRT.


We analyzed 178 consecutive patients who underwent successful CRT device implantation (age 64 ± 11 years; 69% male; 92% in New York Heart Association (NYHA) functional class ≥ III; 34% with ischemic cardiomyopathy). Echocardiographic response was defined as ≥ 15% reduction in left ventricular end-systolic diameter and clinical response as a sustained improvement of at least one NYHA functional class. Renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2.


Renal dysfunction was present in 34.7%. Renal dysfunction was not an independent predictor of echocardiographic response (OR 1.109, 95% CI 0.713–1.725, p 0.646) nor clinical response (OR 1.003; 95% CI 0.997–1.010; p 0.324). During follow-up (mean 55.2 ± 32 months), patients with eGFR < 60mL/min/1.73 m2 had higher overall mortality (HR 4.902, 95% CI 1.118–21.482, p 0.035). However, clinical response in patients with renal dysfunction was independently associated with better long-term survival (HR 0.236, 95% CI 0.073–0.767, p 0.016). Renal function was significantly improved in patients who respond to CRT (ΔeGFR + 5.5 mL/min/1.73 m2 at baseline vs. follow-up, p 0.049), while this was not evident in nonresponders. Improvements in eGFR of at least 10 mL/min/1.73 m2 were associated with improved survival in renal dysfunction patients (log-rank p 0.036).


Renal dysfunction was associated with higher long-term mortality in CRT patients, though, it did not influence echocardiographic nor functional response. Despite worse overall prognosis, renal dysfunction patients who are responders showed long-term survival benefit and improvement in renal function following CRT.


Renal dysfunction Cardiac resynchronization therapy Chronic heart failure Long-term outcome 


Compliance with ethical standards

The study protocol was approved by the local Research Ethics Board.

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Rita Ilhão Moreira
    • 1
    Email author
  • Pedro Silva Cunha
    • 1
  • Pedro Rio
    • 1
  • Manuel Nogueira da Silva
    • 1
  • Luísa Moura Branco
    • 1
  • Ana Galrinho
    • 1
  • Joana Feliciano
    • 1
  • Rui Soares
    • 1
  • Rui Cruz Ferreira
    • 1
  • Mário Martins Oliveira
    • 1
  1. 1.Department of Cardiology, Hospital de Santa MartaCentro Hospitalar Lisboa CentralLisbonPortugal

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