PMID- 29460235 OWN - NLM STAT- MEDLINE DCOM- 20181011 LR - 20191210 IS - 1572-8595 (Electronic) IS - 1383-875X (Linking) VI - 51 IP - 3 DP - 2018 Apr TI - Response and outcomes of cardiac resynchronization therapy in patients with renal dysfunction. PG - 237-244 LID - 10.1007/s10840-018-0330-6 [doi] AB - 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 m(2). 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 m(2) 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 (DeltaeGFR + 5.5 mL/min/1.73 m(2) 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 m(2) 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. FAU - Moreira, Rita Ilhao AU - Moreira RI AUID- ORCID: 0000-0002-1873-0074 AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. ritailhaomoreira@gmail.com. FAU - Cunha, Pedro Silva AU - Cunha PS AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. FAU - Rio, Pedro AU - Rio P AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. FAU - da Silva, Manuel Nogueira AU - da Silva MN AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. FAU - Branco, Luisa Moura AU - Branco LM AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. FAU - Galrinho, Ana AU - Galrinho A AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. FAU - Feliciano, Joana AU - Feliciano J AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. FAU - Soares, Rui AU - Soares R AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. FAU - Ferreira, Rui Cruz AU - Ferreira RC AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. FAU - Oliveira, Mario Martins AU - Oliveira MM AD - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Rua de Santa Marta, n degrees 50, 1169-024, Lisbon, Portugal. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20180219 PL - Netherlands TA - J Interv Card Electrophysiol JT - Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing JID - 9708966 SB - IM MH - Aged MH - Cardiac Pacing, Artificial/*methods/mortality MH - Cardiac Resynchronization Therapy/*methods/mortality MH - Cohort Studies MH - Comorbidity MH - Databases, Factual MH - Female MH - Glomerular Filtration Rate MH - Heart Failure/diagnosis/*epidemiology/*therapy MH - Humans MH - Incidence MH - Kaplan-Meier Estimate MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Prognosis MH - Proportional Hazards Models MH - Renal Insufficiency/diagnosis/*epidemiology/therapy MH - Retrospective Studies MH - Risk Assessment MH - Severity of Illness Index MH - Survival Analysis OTO - NOTNLM OT - Cardiac resynchronization therapy OT - Chronic heart failure OT - Long-term outcome OT - Renal dysfunction EDAT- 2018/02/21 06:00 MHDA- 2018/10/12 06:00 CRDT- 2018/02/21 06:00 PHST- 2017/10/19 00:00 [received] PHST- 2018/02/06 00:00 [accepted] PHST- 2018/02/21 06:00 [pubmed] PHST- 2018/10/12 06:00 [medline] PHST- 2018/02/21 06:00 [entrez] AID - 10.1007/s10840-018-0330-6 [pii] AID - 10.1007/s10840-018-0330-6 [doi] PST - ppublish SO - J Interv Card Electrophysiol. 2018 Apr;51(3):237-244. doi: 10.1007/s10840-018-0330-6. Epub 2018 Feb 19.