Impaired Renal Function Is Associated With Echocardiographic Nonresponse and Poor Prognosis After Cardiac Resynchronization Therapy

• Published in: Journal of the American College of Cardiology 2011-02, Vol.57 (5), p.549-555
• Main Authors: Van Bommel, Rutger J., MD, Mollema, Sjoerd A., MD, PhD, Borleffs, C. Jan Willem, MD, PhD, Bertini, Matteo, MD, Ypenburg, Claudia, MD, PhD, Marsan, Nina Ajmone, MD, Delgado, Victoria, MD, PhD, Van Der Wall, Ernst E., MD, PhD, Schalij, Martin J., MD, PhD, Bax, Jeroen J., MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; cardiac resynchronization therapy; Cardiac Resynchronization Therapy - trends; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Catheters; Confidence intervals; Drug therapy; Echocardiography - trends; Female; Follow-Up Studies; Glomerular Filtration Rate - physiology; Heart attacks; Heart failure; Humans; Internal Medicine; Investigative techniques, diagnostic techniques (general aspects); Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; outcome; Patients; Prognosis; Quality of life; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries; renal function; Renal Insufficiency - diagnostic imaging; Renal Insufficiency - physiopathology; Renal Insufficiency - therapy; Treatment Outcome; Ultrasonic imaging; Ultrasonic investigative techniques; Variance analysis
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.06.060

Objectives Aims of this study were to investigate the effect of renal function on left ventricular (LV) reverse remodeling and long-term outcome after cardiac resynchronization therapy (CRT), and to explore the relation between LV reverse remodeling and changes in renal function at 6-month follow-up. Background Renal insufficiency is highly prevalent in heart failure patients, including patients eligible for CRT, and is associated with poor prognosis. Methods The study comprised 490 patients undergoing CRT. Response to CRT was defined as a decrease in LV end-systolic volume ≥15% at 6-month follow-up. Primary end point during long-term follow-up was all-cause mortality. Results At baseline, mean estimated glomerular filtration rate (eGFR) was 70 ± 28 ml/min/1.73 m2 . At 6-month follow-up, 263 patients (54%) demonstrated response to CRT. Responders had an eGFR of 74 ± 26 ml/min/1.73 m2 versus 64 ± 28 ml/min/1.73 m2 in nonresponders (p < 0.001). During long-term follow-up, patients with an eGFR 90 ml/min/1.73 m2 (p < 0.001). Finally, responders to CRT had preservation of renal function (ΔeGFR −0.6), whereas nonresponders had a slight worsening in renal function (ΔeGFR −4.7, p < 0.05). Conclusions Impaired renal function in CRT candidates is associated with nonresponse during 6-month follow-up. Additionally, patients with impaired renal function have worse long-term survival after CRT. Response to CRT results in preservation of renal function.