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

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Authors

  • 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 units

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.

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  • Renal function and the long term clinical outcomes of cardiac resynchronization

    Rights statement: 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.

    Accepted author manuscript, 1 MB, PDF-document

    Embargo ends: 15/03/20

Details

Original languageEnglish
Pages (from-to)595-602
Number of pages8
JournalPacing and Clinical Electrophysiology
Volume42
Issue number6
Early online date15 Mar 2019
DOIs
Publication statusPublished - 1 Jun 2019

Bibliographic 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

DOI

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