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Response and Outcomes of Cardiac Resynchronization Therapy in Patients with Renal Dysfunction

2018-04Journal article Open access
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dc.contributor.authorIlhão Moreira, R
dc.contributor.authorCunha, PS
dc.contributor.authorRio, P
dc.contributor.authorNogueira da Silva, M
dc.contributor.authorBranco, LM
dc.contributor.authorGalrinho, A
dc.contributor.authorFeliciano, J
dc.contributor.authorSoares, R
dc.contributor.authorCruz Ferreira, R
dc.contributor.authorOliveira, MM
dc.date.accessioned2019-10-11T10:26:41Z
dc.date.available2019-10-11T10:26:41Z
dc.date.issued2018-04
dc.description.abstractPURPOSE: Renal dysfunction is often associated with chronic heart failure, leading to increased morbi-mortality. However, data regarding these patients after cardiac resynchronization therapy (CRT) is sparse. We sought to evaluate response and long-term mortality in patients with heart failure and renal dysfunction and assess renal improvement after CRT. METHODS: We analyzed 178 consecutive patients who underwent successful CRT device implantation (age 64 ± 11 years; 69% male; 92% in New York Heart Association (NYHA) functional class ≥ III; 34% with ischemic cardiomyopathy). Echocardiographic response was defined as ≥ 15% reduction in left ventricular end-systolic diameter and clinical response as a sustained improvement of at least one NYHA functional class. Renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. RESULTS: Renal dysfunction was present in 34.7%. Renal dysfunction was not an independent predictor of echocardiographic response (OR 1.109, 95% CI 0.713-1.725, p 0.646) nor clinical response (OR 1.003; 95% CI 0.997-1.010; p 0.324). During follow-up (mean 55.2 ± 32 months), patients with eGFR < 60mL/min/1.73 m2 had higher overall mortality (HR 4.902, 95% CI 1.118-21.482, p 0.035). However, clinical response in patients with renal dysfunction was independently associated with better long-term survival (HR 0.236, 95% CI 0.073-0.767, p 0.016). Renal function was significantly improved in patients who respond to CRT (ΔeGFR + 5.5 mL/min/1.73 m2 at baseline vs. follow-up, p 0.049), while this was not evident in nonresponders. Improvements in eGFR of at least 10 mL/min/1.73 m2 were associated with improved survival in renal dysfunction patients (log-rank p 0.036). CONCLUSION: Renal dysfunction was associated with higher long-term mortality in CRT patients, though, it did not influence echocardiographic nor functional response. Despite worse overall prognosis, renal dysfunction patients who are responders showed long-term survival benefit and improvement in renal function following CRT.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Interv Card Electrophysiol. 2018 Apr;51(3):237-244.pt_PT
dc.identifier.doi10.1007/s10840-018-0330-6pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3320
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringer Verlagpt_PT
dc.subjectAgedpt_PT
dc.subjectCardiac Pacing, Artificial/methodspt_PT
dc.subjectCardiac Resynchronization Therapy/methodspt_PT
dc.subjectCohort Studiespt_PT
dc.subjectComorbiditypt_PT
dc.subjectDatabases, Factualpt_PT
dc.subjectFemalept_PT
dc.subjectGlomerular Filtration Ratept_PT
dc.subjectHeart Failure/diagnosispt_PT
dc.subjectHumanspt_PT
dc.subjectIncidencept_PT
dc.subjectKaplan-Meier Estimatept_PT
dc.subjectMalept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectMultivariate Analysispt_PT
dc.subjectPrognosispt_PT
dc.subjectProportional Hazards Modelspt_PT
dc.subjectRenal Insufficiency/diagnosispt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectRisk Assessmentpt_PT
dc.subjectSeverity of Illness Indexpt_PT
dc.subjectSurvival Analysispt_PT
dc.subjectHSM CARpt_PT
dc.subjectCardiac Pacing, Artificial/mortality
dc.subjectCardiac Resynchronization Therapy/mortality
dc.subjectHeart Failure/epidemiology
dc.subjectHeart Failure/therapy
dc.subjectRenal Insufficiency/epidemiology
dc.subjectRenal Insufficiency/therapy
dc.titleResponse and Outcomes of Cardiac Resynchronization Therapy in Patients with Renal Dysfunctionpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage244pt_PT
oaire.citation.issue3pt_PT
oaire.citation.startPage237pt_PT
oaire.citation.titleJourtnal of Interventional Cardiac Electrophysiologypt_PT
oaire.citation.volume51pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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