Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation

Francisco Leyva, Abbasin Zegard, Robin Taylor, Paul W.x. Foley, Fraz Umar, Kiran Patel, Jonathan Panting, Charles J. Ferro, Shajil Chalil, Howard Marshall, Tian Qiu

Research output: Contribution to journalArticle

Abstract

Background and Aims: Patients with moderate-to-severe chronic kidney disease (CKD) are underrepresented in clinical trials of cardiac resynchronization therapy (CRT)-defibrillation (CRT-D) or CRT-pacing (CRT-P). We sought to determine whether outcomes after CRT-D are better than after CRT-P over a wide spectrum of CKD. Methods and Results: Clinical events were quantified in relation to preimplant estimated glomerular filtration rate (eGFR) after CRT-D (n = 410 [39.2%]) or CRT-P (n = 636 [60.8%]) implantation. Over a follow-up period of 3.7 years (median, interquartile range: 2.1–5.7), the eGFR < 60 group (n = 598) had a higher risk of total mortality (adjusted hazard ratio [aHR]: 1.28; P = 0.017), total mortality or heart failure (HF) hospitalization (aHR: 1.32; P = 0.004), total mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.34; P = 0.002), and cardiac mortality (aHR: 1.33; P = 0.036), compared to the eGFR ≥ 60 group (n = 448), after covariate adjustment. In analyses of CRT-D versus CRT-P, CRT-D was associated with a lower risk of total mortality (eGFR ≥ 60 HR: 0.65; P = 0.028; eGFR < 60 HR: 0.64, P = 0.002), total mortality or HF hospitalization (eGFR ≥ 60 aHR: 0.66; P = 0.021; eGFR < 60 aHR: 0.69, P = 0.007), total mortality or hospitalization for MACEs (eGFR ≥ 60 aHR: 0.70; P = 0.039; eGFR < 60 aHR: 0.69, P = 0.005), and cardiac mortality (eGFR ≥ 60 aHR: 0.60; P = 0.026; eGFR < 60 aHR: 0.55; P = 0.003). Conclusion: In CRT recipients, moderate CKD is associated with a higher mortality and morbidity compared to normal renal function or mild CKD. Despite less favorable absolute outcomes, patients with moderate CKD had better outcomes after CRT-D than after CRT-P.

LanguageEnglish
Pages595-602
Number of pages8
JournalPacing and Clinical Electrophysiology
Volume42
Issue number6
Early online date15 Mar 2019
DOIs
Publication statusPublished - 1 Jun 2019

Fingerprint

Cardiac Resynchronization Therapy
Glomerular Filtration Rate
Kidney
Mortality
Chronic Renal Insufficiency
Hospitalization
Heart Failure

Bibliographical note

This is the peer reviewed version of the following article: Leyva, F. , Zegard, A. , Taylor, R. , Foley, P. W., Umar, F. , Patel, K. , Panting, J. , Ferro, C. J., Chalil, S. , Marshall, H. and Qiu, T. (2019), Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation. Pacing Clin Electrophysiol. Accepted Author Manuscript, which has been published in final form at https://doi.org/10.1111/pace.13659.  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.

Keywords

  • cardiac resynchronization therapy
  • chronic kidney disease
  • heart failure
  • implantable cardioverter defibrillator

Cite this

Leyva, Francisco ; Zegard, Abbasin ; Taylor, Robin ; Foley, Paul W.x. ; Umar, Fraz ; Patel, Kiran ; Panting, Jonathan ; Ferro, Charles J. ; Chalil, Shajil ; Marshall, Howard ; Qiu, Tian. / Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation. 2019 ; Vol. 42, No. 6. pp. 595-602.
@article{632b6d6b1ec64a93bf7b698102453e4f,
title = "Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation",
abstract = "Background and Aims: Patients with moderate-to-severe chronic kidney disease (CKD) are underrepresented in clinical trials of cardiac resynchronization therapy (CRT)-defibrillation (CRT-D) or CRT-pacing (CRT-P). We sought to determine whether outcomes after CRT-D are better than after CRT-P over a wide spectrum of CKD. Methods and Results: Clinical events were quantified in relation to preimplant estimated glomerular filtration rate (eGFR) after CRT-D (n = 410 [39.2{\%}]) or CRT-P (n = 636 [60.8{\%}]) implantation. Over a follow-up period of 3.7 years (median, interquartile range: 2.1–5.7), the eGFR < 60 group (n = 598) had a higher risk of total mortality (adjusted hazard ratio [aHR]: 1.28; P = 0.017), total mortality or heart failure (HF) hospitalization (aHR: 1.32; P = 0.004), total mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.34; P = 0.002), and cardiac mortality (aHR: 1.33; P = 0.036), compared to the eGFR ≥ 60 group (n = 448), after covariate adjustment. In analyses of CRT-D versus CRT-P, CRT-D was associated with a lower risk of total mortality (eGFR ≥ 60 HR: 0.65; P = 0.028; eGFR < 60 HR: 0.64, P = 0.002), total mortality or HF hospitalization (eGFR ≥ 60 aHR: 0.66; P = 0.021; eGFR < 60 aHR: 0.69, P = 0.007), total mortality or hospitalization for MACEs (eGFR ≥ 60 aHR: 0.70; P = 0.039; eGFR < 60 aHR: 0.69, P = 0.005), and cardiac mortality (eGFR ≥ 60 aHR: 0.60; P = 0.026; eGFR < 60 aHR: 0.55; P = 0.003). Conclusion: In CRT recipients, moderate CKD is associated with a higher mortality and morbidity compared to normal renal function or mild CKD. Despite less favorable absolute outcomes, patients with moderate CKD had better outcomes after CRT-D than after CRT-P.",
keywords = "cardiac resynchronization therapy, chronic kidney disease, heart failure, implantable cardioverter defibrillator",
author = "Francisco Leyva and Abbasin Zegard and Robin Taylor and Foley, {Paul W.x.} and Fraz Umar and Kiran Patel and Jonathan Panting and Ferro, {Charles J.} and Shajil Chalil and Howard Marshall and Tian Qiu",
note = "This is the peer reviewed version of the following article: Leyva, F. , Zegard, A. , Taylor, R. , Foley, P. W., Umar, F. , Patel, K. , Panting, J. , Ferro, C. J., Chalil, S. , Marshall, H. and Qiu, T. (2019), Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation. Pacing Clin Electrophysiol. Accepted Author Manuscript, which has been published in final form at https://doi.org/10.1111/pace.13659.  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.",
year = "2019",
month = "6",
day = "1",
doi = "10.1111/pace.13659",
language = "English",
volume = "42",
pages = "595--602",
number = "6",

}

Leyva, F, Zegard, A, Taylor, R, Foley, PWX, Umar, F, Patel, K, Panting, J, Ferro, CJ, Chalil, S, Marshall, H & Qiu, T 2019, 'Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation' vol. 42, no. 6, pp. 595-602. https://doi.org/10.1111/pace.13659

Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation. / Leyva, Francisco; Zegard, Abbasin; Taylor, Robin; Foley, Paul W.x.; Umar, Fraz; Patel, Kiran; Panting, Jonathan; Ferro, Charles J.; Chalil, Shajil; Marshall, Howard; Qiu, Tian.

Vol. 42, No. 6, 01.06.2019, p. 595-602.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation

AU - Leyva, Francisco

AU - Zegard, Abbasin

AU - Taylor, Robin

AU - Foley, Paul W.x.

AU - Umar, Fraz

AU - Patel, Kiran

AU - Panting, Jonathan

AU - Ferro, Charles J.

AU - Chalil, Shajil

AU - Marshall, Howard

AU - Qiu, Tian

N1 - This is the peer reviewed version of the following article: Leyva, F. , Zegard, A. , Taylor, R. , Foley, P. W., Umar, F. , Patel, K. , Panting, J. , Ferro, C. J., Chalil, S. , Marshall, H. and Qiu, T. (2019), Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation. Pacing Clin Electrophysiol. Accepted Author Manuscript, which has been published in final form at https://doi.org/10.1111/pace.13659.  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background and Aims: Patients with moderate-to-severe chronic kidney disease (CKD) are underrepresented in clinical trials of cardiac resynchronization therapy (CRT)-defibrillation (CRT-D) or CRT-pacing (CRT-P). We sought to determine whether outcomes after CRT-D are better than after CRT-P over a wide spectrum of CKD. Methods and Results: Clinical events were quantified in relation to preimplant estimated glomerular filtration rate (eGFR) after CRT-D (n = 410 [39.2%]) or CRT-P (n = 636 [60.8%]) implantation. Over a follow-up period of 3.7 years (median, interquartile range: 2.1–5.7), the eGFR < 60 group (n = 598) had a higher risk of total mortality (adjusted hazard ratio [aHR]: 1.28; P = 0.017), total mortality or heart failure (HF) hospitalization (aHR: 1.32; P = 0.004), total mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.34; P = 0.002), and cardiac mortality (aHR: 1.33; P = 0.036), compared to the eGFR ≥ 60 group (n = 448), after covariate adjustment. In analyses of CRT-D versus CRT-P, CRT-D was associated with a lower risk of total mortality (eGFR ≥ 60 HR: 0.65; P = 0.028; eGFR < 60 HR: 0.64, P = 0.002), total mortality or HF hospitalization (eGFR ≥ 60 aHR: 0.66; P = 0.021; eGFR < 60 aHR: 0.69, P = 0.007), total mortality or hospitalization for MACEs (eGFR ≥ 60 aHR: 0.70; P = 0.039; eGFR < 60 aHR: 0.69, P = 0.005), and cardiac mortality (eGFR ≥ 60 aHR: 0.60; P = 0.026; eGFR < 60 aHR: 0.55; P = 0.003). Conclusion: In CRT recipients, moderate CKD is associated with a higher mortality and morbidity compared to normal renal function or mild CKD. Despite less favorable absolute outcomes, patients with moderate CKD had better outcomes after CRT-D than after CRT-P.

AB - Background and Aims: Patients with moderate-to-severe chronic kidney disease (CKD) are underrepresented in clinical trials of cardiac resynchronization therapy (CRT)-defibrillation (CRT-D) or CRT-pacing (CRT-P). We sought to determine whether outcomes after CRT-D are better than after CRT-P over a wide spectrum of CKD. Methods and Results: Clinical events were quantified in relation to preimplant estimated glomerular filtration rate (eGFR) after CRT-D (n = 410 [39.2%]) or CRT-P (n = 636 [60.8%]) implantation. Over a follow-up period of 3.7 years (median, interquartile range: 2.1–5.7), the eGFR < 60 group (n = 598) had a higher risk of total mortality (adjusted hazard ratio [aHR]: 1.28; P = 0.017), total mortality or heart failure (HF) hospitalization (aHR: 1.32; P = 0.004), total mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.34; P = 0.002), and cardiac mortality (aHR: 1.33; P = 0.036), compared to the eGFR ≥ 60 group (n = 448), after covariate adjustment. In analyses of CRT-D versus CRT-P, CRT-D was associated with a lower risk of total mortality (eGFR ≥ 60 HR: 0.65; P = 0.028; eGFR < 60 HR: 0.64, P = 0.002), total mortality or HF hospitalization (eGFR ≥ 60 aHR: 0.66; P = 0.021; eGFR < 60 aHR: 0.69, P = 0.007), total mortality or hospitalization for MACEs (eGFR ≥ 60 aHR: 0.70; P = 0.039; eGFR < 60 aHR: 0.69, P = 0.005), and cardiac mortality (eGFR ≥ 60 aHR: 0.60; P = 0.026; eGFR < 60 aHR: 0.55; P = 0.003). Conclusion: In CRT recipients, moderate CKD is associated with a higher mortality and morbidity compared to normal renal function or mild CKD. Despite less favorable absolute outcomes, patients with moderate CKD had better outcomes after CRT-D than after CRT-P.

KW - cardiac resynchronization therapy

KW - chronic kidney disease

KW - heart failure

KW - implantable cardioverter defibrillator

UR - https://onlinelibrary.wiley.com/doi/abs/10.1111/pace.13659

UR - http://www.scopus.com/inward/record.url?scp=85063567587&partnerID=8YFLogxK

U2 - 10.1111/pace.13659

DO - 10.1111/pace.13659

M3 - Article

VL - 42

SP - 595

EP - 602

IS - 6

ER -