Outcomes of cardiac resynchronization therapy with or without defibrillation in patients with nonischemic cardiomyopathy

Francisco Leyva*, Abbasin Zegard, Edmund Acquaye, Christopher Gubran, Robin Taylor, Paul W.X. Foley, Fraz Umar, Kiran Patel, Jonathan Panting, Howard Marshall, Tian Qiu

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background Recent studies have cast doubt on the benefit of cardiac resynchronization therapy (CRT) with defibrillation (CRT-D) versus pacing (CRT-P) for patients with nonischemic cardiomyopathy (NICM). Left ventricular myocardial scar portends poor clinical outcomes. Objectives The aim of this study was to determine whether CRT-D is superior to CRT-P in patients with NICM either with (+) or without (−) left ventricular midwall fibrosis (MWF), detected by cardiac magnetic resonance. Methods Clinical events were quantified in patients with NICM who were +MWF (n = 68) or −MWF (n = 184) who underwent cardiac magnetic resonance prior to CRT device implantation. Results In the total study population, +MWF emerged as an independent predictor of total mortality (adjusted hazard ratio [aHR]: 2.31; 95% confidence interval [CI]: 1.45 to 3.68), total mortality or heart failure hospitalization (aHR: 2.02; 95% CI: 1.32 to 3.09), total mortality or hospitalization for major adverse cardiac events (aHR: 2.02; 95% CI: 1.32 to 3.07), death from pump failure (aHR: 1.95; 95% CI: 1.11 to 3.41), and sudden cardiac death (aHR: 3.75; 95% CI: 1.26 to 11.2) over a maximum follow-up period of 14 years (median 3.8 years [interquartile range: 2.0 to 6.1 years] for +MWF and 4.6 years [interquartile range: 2.4 to 8.3 years] for −MWF). In separate analyses of +MWF and −MWF, total mortality (aHR: 0.23; 95% CI: 0.07 to 0.75), total mortality or heart failure hospitalization (aHR: 0.32; 95% CI: 0.12 to 0.82), and total mortality or hospitalization for major adverse cardiac events (aHR: 0.30; 95% CI: 0.12 to 0.78) were lower after CRT-D than after CRT-P in +MWF but not in −MWF. Conclusions In patients with NICM, CRT-D was superior to CRT-P in +MWF but not −MWF. These findings have implications for the choice of device therapy in patients with NICM.

Original languageEnglish
Pages (from-to)1216-1227
Number of pages12
JournalJournal of the American College of Cardiology
Volume70
Issue number10
Early online date28 Aug 2017
DOIs
Publication statusPublished - 5 Sep 2017

Bibliographical note

© 2017 The Authors. This is as open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords

  • cardiac magnetic resonance imaging
  • heart failure
  • implantable cardioverter-defibrillator
  • major adverse cardiac events
  • pacing

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    Leyva, F., Zegard, A., Acquaye, E., Gubran, C., Taylor, R., Foley, P. W. X., Umar, F., Patel, K., Panting, J., Marshall, H., & Qiu, T. (2017). Outcomes of cardiac resynchronization therapy with or without defibrillation in patients with nonischemic cardiomyopathy. Journal of the American College of Cardiology, 70(10), 1216-1227. https://doi.org/10.1016/j.jacc.2017.07.712