Comorbidity Significantly Affects Clinical Outcome After Cardiac Resynchronization Therapy Regardless of Ventricular Remodeling

Verbrugge, Frederik H.; Dupont, Matthias; Rivero‐Ayerza, Máximo; Vusser, Philip De; Herendael, Hugo Van; Vercammen, Jan; Jacobs, Linda; Verhaert, David; Vandervoort, Pieter M.; Tang, W.H. Wilson; Mullens, Wilfried

doi:10.1016/j.cardfail.2012.09.003

Cited by 32 publications

(26 citation statements)

References 40 publications

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“…Forty-eight unique studies were selected for full-text review. Eighteen studies met all inclusion criteria and were included in the systematic review: 14 observational studies and 4 RCTs (11,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). To evaluate the effect on survival outcomes, studies were classified into the following two groups: (1) comparing outcomes in all CKD patients who had CRT versus those without CRT and (2) comparing post-CRT outcomes in patients with baseline CKD versus those without CKD.…”

Section: Search Resultsmentioning

confidence: 99%

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Cardiac Resynchronization Therapy in CKD

Garg

Thomas

Jackson

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground Cardiac resynchronization therapy (CRT) confers morbidity and mortality benefits to selected patients with heart failure. This systematic review examined effects of CRT in CKD patients (estimated GFR [eGFR] ,60 ml/min per 1.73 m 2 ).Design, setting, participants, & measurements MEDLINE and Scopus (from 1990 to December 2012) and conference proceedings abstracts were searched for relevant observational studies and randomized controlled trials (RCTs). Studies comparing the following outcomes were included: (1) CKD patients with and without CRT and (2) CKD patients with CRT to non-CKD patients with CRT. Mortality, eGFR, and left ventricular ejection fraction data were extracted and pooled when appropriate using a random-effects model.Results Eighteen studies (14 observational studies and 4 RCTs) were included. There was a modest improvement in eGFR with CRT among CKD patients (mean difference 2.30 ml/min per 1.73m 2 ; 95% confidence interval, 0.33 to 4.27). Similarly, there was a significant improvement in left ventricular ejection with CRT in CKD patients (mean difference 6.24%; 95% confidence interval, 3.46 to 9.07). Subgroup analysis of three RCTs reported lower rates of death or hospitalization for heart failure with CRT (versus other therapy) in the CKD population. Survival outcomes of CKD patients (compared with the non-CKD population) with CRT differed among observational studies and RCTs.Conclusions CRT improves left ventricular and renal function in the CKD population with heart failure. Given the increasing use of cardiac devices, further studies examining the effects of CRT on mortality in CKD patients, particularly those with advanced kidney disease, are warranted.

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Section: Search Resultsmentioning

confidence: 99%

“…Three studies reported symptomatic benefit with significant improvement in NYHA class and 6-minute walk test score with the use of CRT in the CKD population (29,32,39 …”

Section: Miscellaneous Outcomesmentioning

confidence: 99%

Cardiac Resynchronization Therapy in CKD

Garg

Thomas

Jackson

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Some have found that diabetes mellitus is not related to prognosis among patients receiving CRT-D therapy, [8][9][10][11][12] others have reported worse outcomes. [13][14][15][16] A meta-analysis of the post hoc analyses of individual randomized trials of CRT (including 5 randomized controlled trials with 2923 patients, among whom 955 with diabetes mellitus) found that diabetes mellitus increased the risk of death after device insertion. 25 Because of potential differences between the populations enrolled in trials and those receiving device therapy in practice, 26 observational studies provide complementary information.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Mellitus and Outcomes of Cardiac Resynchronization With Implantable Cardioverter-Defibrillator Therapy in Older Patients With Heart Failure

Echouffo‐Tcheugui

Masoudi

Bao

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background— Large-scale data on outcomes with cardiac resynchronization therapy with defibrillator in patients with diabetes mellitus are limited. We compared outcomes after cardiac resynchronization therapy with defibrillator implantation among patients with heart failure who have diabetes mellitus versus those without diabetes mellitus. Methods and Results— Survival curves and covariate adjusted hazard ratio (HR) or odds ratio were used to assess the risks for death, readmission, and device-related complications by diabetes mellitus status among 18 428 patients at least 65 years old receiving cardiac resynchronization therapy with defibrillator from the National Cardiovascular Data Registry, implantable cardioverter-defibrillator registry between 2006 and 2009, with up to 3 years of follow-up. Accounting for differences between groups, compared with those without diabetes mellitus (n=11 345), patients with diabetes mellitus (n=7083) had a higher risk of death both at 1 year (HR, 1.16 [95% confidence interval (CI), 1.05–1.29]; P =0.0037) and 3 years (HR, 1.21 [1.14–1.29]; P <0.001) after device implantation and higher risks of all-cause readmission (sub-HR, 1.16 [1.11–1.21] at 1 year; P <0.0001; sub-HR, 1.15 [1.11–1.19] at 3 years; P <0.0001) and heart failure–related readmission (sub-HR, 1.18 [1.09–1.28] at 1 year; P <0.0001; and sub-HR, 1.22 [1.15–1.30] at 3 years; P <0.0001). Device-related complications within 90 days did not differ between those with and without diabetes mellitus (odds ratio: 0.90 [0.77–1.06]; P =0.37). Interactions of age, sex, ischemic cardiomyopathy, renal failure, or QRS duration were not significant. Conclusions— In older patients with heart failure receiving cardiac resynchronization therapy with defibrillator, diabetes mellitus was independently associated with greater risks of death and rehospitalization, but similar risks of procedural complications.

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“…1,13 The most evident and measurable effect of CRT is the reduction of left ventricular volumes, so-called left ventricular reverse remodeling. [12][13][14] It is noteworthy that the response to CRT in terms of reverse ventricular remodeling and improvement in functional status after CRT implantation was found to be independent from most common comorbidities (including diabetes mellitus and CKD), but diabetes mellitus and CKD had an important impact on outcome, with a 3-fold increase in mortality risk. 14 In a real-world long-term registry of around 700 CRT-D patients followed for 4 years, Boriani et al 15 found a 3-year 2 Boriani Diabetes, Comorbidities, and CRT mortality rate similar to that reported by Echouffo-Tcheugui et al 9 Moreover, comorbidities (expressed by the Charlson comorbidity index), as well as age, male sex, advanced NYHA class and implant during unplanned, urgent hospitalization were significant independent predictors of death/cardiac transplant.…”

Section: See Article By Echouffo-tcheugui Et Almentioning

confidence: 99%

“…[12][13][14] It is noteworthy that the response to CRT in terms of reverse ventricular remodeling and improvement in functional status after CRT implantation was found to be independent from most common comorbidities (including diabetes mellitus and CKD), but diabetes mellitus and CKD had an important impact on outcome, with a 3-fold increase in mortality risk. 14 In a real-world long-term registry of around 700 CRT-D patients followed for 4 years, Boriani et al 15 found a 3-year 2 Boriani Diabetes, Comorbidities, and CRT mortality rate similar to that reported by Echouffo-Tcheugui et al 9 Moreover, comorbidities (expressed by the Charlson comorbidity index), as well as age, male sex, advanced NYHA class and implant during unplanned, urgent hospitalization were significant independent predictors of death/cardiac transplant. 15 The impact of diabetes mellitus as a comorbidity on the risk of hospitalizations and HF-related hospitalizations after CRT-D implantation is evident in the report by Echouffo-Tcheugui et al 9 The assessment of freedom from first rehospitalization, as done in this report, has some limitations in quantifying patient outcome.…”

Section: See Article By Echouffo-tcheugui Et Almentioning

confidence: 99%

The Impact of Diabetes and Comorbidities on the Outcome of Heart Failure Patients Treated With Cardiac Resynchronization Therapy

Boriani

2016

Circ: Arrhythmia and Electrophysiology

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Comorbidity Significantly Affects Clinical Outcome After Cardiac Resynchronization Therapy Regardless of Ventricular Remodeling

Cited by 32 publications

References 40 publications

Cardiac Resynchronization Therapy in CKD

Cardiac Resynchronization Therapy in CKD

Diabetes Mellitus and Outcomes of Cardiac Resynchronization With Implantable Cardioverter-Defibrillator Therapy in Older Patients With Heart Failure

The Impact of Diabetes and Comorbidities on the Outcome of Heart Failure Patients Treated With Cardiac Resynchronization Therapy

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