Long-Term Outcomes With Cardiac Resynchronization Therapy in Patients With Mild Heart Failure With Moderate Renal Dysfunction

Circ Heart Fail. 2015 Jul;8(4):725-32. doi: 10.1161/CIRCHEARTFAILURE.115.002082. Epub 2015 Jun 2.

Abstract

Background: We aimed to determine the impact of renal function on long-term outcomes with cardiac resynchronization therapy with defibrillator among patients with mild heart failure (HF).

Methods and results: We stratified 1820 Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy patients by QRS morphology into those with and without left bundle-branch block. Subgroups within each QRS morphology category were created based on glomerular filtration rate (GFR): GFR <60 and ≥60 mL/min per 1.73 m(2). Primary end point was death; secondary end points were HF/death and HF events alone during long-term follow-up. Among 1274 left bundle-branch block patients, 413 (32%) presented with GFR <60 (mean, 48.1±8.3) mL/min per 1.73 m(2). Relative to the 861 (68%) patients with GFR ≥60 (mean, 79.6±16.0) mL/min per 1.73 m(2), low-GFR patients experienced higher risk of death (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.53-2.86; P<0.01) and HF/death (HR, 1.46; 95% CI, 1.17-1.82; P<0.01). In both GFR groups, cardiac resynchronization therapy with defibrillator was associated with reduction in death (GFR <60: HR, 0.66; 95% CI, 0.44-1.00; P=0.05 and GFR ≥60: HR, 0.68; 95% CI, 0.44-1.05; P=0.08) and HF/death (GFR <60: HR, 0.49; 95% CI, 0.36-0.67; P<0.01 and GFR ≥60: HR, 0.50; 95% CI, 0.38-0.66; P<0.01). In the low-GFR group, there was greater absolute reduction in risk of death (GFR <60: 14% and GFR ≥60: 6%) and HF/death (GFR <60: 25 and GFR ≥60: 15%). Among non-left bundle-branch block patients, low GFR predicted outcomes; however, no benefit from cardiac resynchronization therapy with defibrillator was observed.

Conclusions: In patients with mild HF, moderate renal dysfunction is associated with higher risk of death and HF during long-term follow-up. Patients with left bundle-branch block, regardless of baseline renal function, derive long-term benefit from cardiac resynchronization therapy with defibrillator, with greater absolute risk reduction in death and HF among those with moderate renal dysfunction.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00180271, NCT01294449, and NCT02060110.

Keywords: bundle-branch block; cardiac resynchronization therapy; defibrillators, implantable; heart failure; mortality; renal insufficiency.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bundle-Branch Block / diagnosis
  • Bundle-Branch Block / mortality
  • Bundle-Branch Block / physiopathology
  • Bundle-Branch Block / therapy*
  • Cardiac Resynchronization Therapy Devices
  • Cardiac Resynchronization Therapy* / adverse effects
  • Cardiac Resynchronization Therapy* / mortality
  • Comorbidity
  • Defibrillators, Implantable
  • Electric Countershock* / adverse effects
  • Electric Countershock* / instrumentation
  • Electric Countershock* / mortality
  • Female
  • Glomerular Filtration Rate
  • Heart Failure / diagnosis
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Humans
  • Kaplan-Meier Estimate
  • Kidney / physiopathology*
  • Kidney Diseases / diagnosis
  • Kidney Diseases / mortality
  • Kidney Diseases / physiopathology*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT00180271
  • ClinicalTrials.gov/NCT01294449
  • ClinicalTrials.gov/NCT02060110