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. 2017 Dec;109(6):569-578.
doi: 10.5935/abc.20170171. Epub 2017 Nov 27.

Predictors of Total Mortality and Echocardiographic Response for Cardiac Resynchronization Therapy: A Cohort Study

[Article in English, Portuguese]
Guilherme Ferreira Gazzoni  1   2 , Matheus Bom Fraga  1 , Andres Di Leoni Ferrari  1 , Pablo da Costa Soliz  1 , Anibal Pires Borges  1 , Eduardo Bartholomay  1 , Carlos Antonio Abunader Kalil  1 , Vanessa Giaretta  2 , Luis Eduardo Paim Rohde  2
Affiliations

Predictors of Total Mortality and Echocardiographic Response for Cardiac Resynchronization Therapy: A Cohort Study

[Article in English, Portuguese]
Guilherme Ferreira Gazzoni et al. Arq Bras Cardiol. 2017 Dec.

Abstract

Background: Clinical studies demonstrate that up to 40% of patients do not respond to cardiac resynchronization therapy (CRT), thus, appropriate patient selection is critical to the success of CRT in heart failure.

Objective: Evaluation of mortality predictors and response to CRT in the Brazilian scenario.

Methods: Retrospective cohort study including patients submitted to CRT in a tertiary hospital in southern Brazil from 2008 to 2014. Survival was assessed through a database of the State Department of Health (RS). Predictors of echocardiographic response were evaluated using Poisson regression. Survival analysis was performed by Cox regression and Kaplan Meyer curves. A two-tailed p value less than 0.05 was considered statistically significant.

Results: A total of 170 patients with an average follow-up of 1011 ± 632 days were included. The total mortality was 30%. The independent predictors of mortality were age (hazard ratio [HR] of 1.05, p = 0.027), previous acute myocardial infarction (AMI) (HR of 2.17, p = 0.049) and chronic obstructive pulmonary disease (COPD) (HR of 3.13, p = 0.015). The percentage of biventricular stimulation at 6 months was identified as protective factor of mortality ([HR] 0.97, p = 0.048). The independent predictors associated with the echocardiographic response were absence of mitral insufficiency, presence of left bundle branch block and percentage of biventricular stimulation.

Conclusion: Mortality in patients submitted to CRT in a tertiary hospital was independently associated with age, presence of COPD and previous AMI. The percentage of biventricular pacing evaluated 6 months after resynchronizer implantation was independently associated with improved survival and echocardiographic response.

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Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Kaplan-Meyer curve of total mortality (A) and total survival free of death or hospitalization (B) stratified by presence of AMI and total mortality (C) and total survival free of death or hospitalization (D) stratified by the presence of biventricular pacing greater than or equal to 95%.
Figure 2
Figure 2
Kaplan-Meyer curve of total mortality (A) and total survival free of death or hospitalization (B) stratified by ecocardiographic response.
See this image and copyright information in PMC

References

    1. Cleland J, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. Cardiac Resynchronization-Heart Failure Study Investigators The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–1549. doi: 10.1056/NEJMoa050496. - DOI - PubMed
    1. Abraham WT, Fisher WG, Smith AL, DeLurgio DB, Leon AR, Loh E, et al. MIRACLE Study Group Multicenter InSync Randomized Clinical Evaluation Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845–1853. doi: 10.1056/NEJMoa013168. - DOI - PubMed
    1. Kandala J, Upadhyay GA, Altman RK, Parks KA, Orencole M, Mela T, et al. QRS morphology, left ventricular lead location, and clinical outcome in patients receiving cardiac resynchronization therapy. Eur Heart J. 2013;34(29):2252–2262. doi: 10.1093/eurheartj/eht123. - DOI - PubMed
    1. Bristow M, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure Investigators Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–2150. doi: 10.1056/NEJMoa032423. - DOI - PubMed
    1. McAlister F, Ezekowitz J, Hooton N, Vandermeer B, Spooner C, Dryden DM, et al. Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: a systematic review. JAMA. 2007;297(22):2502–2514. doi: 10.1001/jama.297.22.2502. - DOI - PubMed

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