Predictors of Total Mortality and Echocardiographic Response for Cardiac Resynchronization Therapy: A Cohort Study

Abstract

BackgroundClinical studies demonstrate that up to 40% of patients do not respond to cardiac resynchronization therapy (CRT), thus, appropriate patient selection is critical to the success of CRT in heart failure.ObjectiveEvaluation of mortality predictors and response to CRT in the Brazilian scenario.MethodsRetrospective cohort study including patients submitted to CRT in a tertiary hospital in southern Brazil from 2008 to 2014. Survival was assessed through a database of the State Department of Health (RS). Predictors of echocardiographic response were evaluated using Poisson regression. Survival analysis was performed by Cox regression and Kaplan Meyer curves. A two-tailed p value less than 0.05 was considered statistically significant.ResultsA total of 170 patients with an average follow-up of 1011 ± 632 days were included. The total mortality was 30%. The independent predictors of mortality were age (hazard ratio [HR] of 1.05, p = 0.027), previous acute myocardial infarction (AMI) (HR of 2.17, p = 0.049) and chronic obstructive pulmonary disease (COPD) (HR of 3.13, p = 0.015). The percentage of biventricular stimulation at 6 months was identified as protective factor of mortality ([HR] 0.97, p = 0.048). The independent predictors associated with the echocardiographic response were absence of mitral insufficiency, presence of left bundle branch block and percentage of biventricular stimulation.ConclusionMortality in patients submitted to CRT in a tertiary hospital was independently associated with age, presence of COPD and previous AMI. The percentage of biventricular pacing evaluated 6 months after resynchronizer implantation was independently associated with improved survival and echocardiographic response.

TNNT2 as a potential biomarker for the progression and prognosis of colorectal cancer

“…Statistical analysis. Cox regression analysis was performed by using survival and survminer packages in R software (22). Clinical factors, including age, sex, TNM staging system [American Joint Committee on Cancer (AJCC) (23) and the International Union Against Cancer (UICC) (24)] and gene expression levels, were adjusted in the Cox regression model.…”

Comparison of Tricuspid Regurgitation Severity Between Cardiac Resynchronization Therapy Versus Right Ventricular Pacing in Patients With Chronic Obstructive Pulmonary Disease

“…However, there are likely multiple confounding factors that need to be considered in this patient population including medication tolerability as well as multifactorial dyspnea [ 30 ]. Gazzoni et al concluded that age, COPD, and prior myocardial infarctions were independent predictors for total mortality in patients receiving CRT devices [ 31 ]. This finding is likely related to the effects of comorbid conditions on overall heart failure outcomes and mortality [ 31 ].…”

“…Gazzoni et al concluded that age, COPD, and prior myocardial infarctions were independent predictors for total mortality in patients receiving CRT devices [ 31 ]. This finding is likely related to the effects of comorbid conditions on overall heart failure outcomes and mortality [ 31 ].…”

Health, work and presence of cardiovascular risk factors in professors at a public university

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