Autor(es):
Ilhão Moreira, R ; Cunha, PS ; Rio, P ; Nogueira da Silva, M ; Branco, LM ; Galrinho, A ; Feliciano, J ; Soares, R ; Cruz Ferreira, R ; Oliveira, MM
Data: 2018
Identificador Persistente: http://hdl.handle.net/10400.17/3320
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): Aged; Cardiac Pacing, Artificial/methods; Cardiac Resynchronization Therapy/methods; Cohort Studies; Comorbidity; Databases, Factual; Female; Glomerular Filtration Rate; Heart Failure/diagnosis; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Prognosis; Proportional Hazards Models; Renal Insufficiency/diagnosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Analysis; HSM CAR; Cardiac Pacing, Artificial/mortality; Cardiac Resynchronization Therapy/mortality; Heart Failure/epidemiology; Heart Failure/therapy; Renal Insufficiency/epidemiology; Renal Insufficiency/therapy
Descrição
PURPOSE: 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.
