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

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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

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

Notes

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
  • 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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