PMID- 33257952 OWN - NLM STAT- MEDLINE DCOM- 20210726 LR - 20210726 IS - 1532-2092 (Electronic) IS - 1099-5129 (Linking) VI - 23 IP - 1 DP - 2021 Jan 27 TI - Upgrade from implantable cardioverter-defibrillator vs. de novo implantation of cardiac resynchronization therapy: long-term outcomes. PG - 113-122 LID - 10.1093/europace/euaa339 [doi] AB - AIMS: To assess and compare long-term mortality and predictors thereof in de novo cardiac resynchronization therapy defibrillators (CRT-D) vs. upgrade from an implantable cardioverter-defibrillator (ICD) to CRT-D. METHODS AND RESULTS: Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in a tertiary care, university hospital, in a densely inhabited, urban region of Poland [480 subjects (84.3%) with CRT-D de novo implantation; 115 patients (15.7%) upgraded from ICD to CRT-D]. In a median observation of 1692 days (range 457-3067), all-cause mortality for de novo CRT-D vs. CRT-D upgrade was 35.5% vs. 43.5%, respectively (P = 0.045). On multivariable regression analysis including all CRT recipients, the previously implanted ICD was an independent predictor for death [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.10-2.29, P = 0.02]. For those, who were upgraded from ICD to CRT-D, the independent predictors for all-cause death were as follows: creatinine level (HR 1.01, 95% CI 1.00-1.02, P = 0.01), left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02-1.11, P = 0.002), New York Heart Association (NYHA) IV class at baseline (HR 2.36, 95% CI 1.00-5.53, P = 0.049) and cardiac device-related infective endocarditis during follow-up (HR 2.42, 95% CI 1.02-5.75, P = 0.046). A new CRT scale (Creatinine >/=150 mumol/L; Remodelling, left ventricular end-systolic >/=59 mm; Threshold for NYHA, NYHA = IV) showed high prediction for mortality in CRT-D upgrades (AUC 0.70, 95% CI 0.59-0.80, P = 0.0007). CONCLUSION: All-cause mortality in patients upgraded from ICD is significantly higher compared with de novo CRT-D implantations and reaches almost 45% within 4.5 years. A new CRT scale (Creatinine; Remodelling; Threshold for NYHA) has been proposed to help survival prediction following CRT upgrade. CI - Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. FAU - Jedrzejczyk-Patej, Ewa AU - Jedrzejczyk-Patej E AD - Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Sklodowskiej-Curie 9, 41-800 Zabrze, Poland. FAU - Mazurek, Michal AU - Mazurek M AD - Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Sklodowskiej-Curie 9, 41-800 Zabrze, Poland. FAU - Kotalczyk, Agnieszka AU - Kotalczyk A AD - Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Sklodowskiej-Curie 9, 41-800 Zabrze, Poland. FAU - Kowalska, Wiktoria AU - Kowalska W AD - Students Scientific Society, Department of Cardiology, Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland. FAU - Konieczny-Kozielska, Aleksandra AU - Konieczny-Kozielska A AD - Students Scientific Society, Department of Cardiology, Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland. FAU - Kozielski, Jonasz AU - Kozielski J AD - Students Scientific Society, Department of Cardiology, Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland. FAU - Podolecki, Tomasz AU - Podolecki T AD - Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Sklodowskiej-Curie 9, 41-800 Zabrze, Poland. FAU - Szulik, Mariola AU - Szulik M AD - Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Sklodowskiej-Curie 9, 41-800 Zabrze, Poland. FAU - Sokal, Adam AU - Sokal A AD - Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Sklodowskiej-Curie 9, 41-800 Zabrze, Poland. FAU - Kowalski, Oskar AU - Kowalski O AD - Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Sklodowskiej-Curie 9, 41-800 Zabrze, Poland. FAU - Kalarus, Zbigniew AU - Kalarus Z AD - Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland. FAU - Sredniawa, Beata AU - Sredniawa B AD - Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland. FAU - Lenarczyk, Radoslaw AU - Lenarczyk R AD - Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Sklodowskiej-Curie 9, 41-800 Zabrze, Poland. LA - eng PT - Journal Article PL - England TA - Europace JT - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JID - 100883649 SB - IM MH - *Cardiac Resynchronization Therapy MH - Cardiac Resynchronization Therapy Devices MH - *Defibrillators, Implantable MH - *Heart Failure/diagnosis/therapy MH - Humans MH - Poland MH - Treatment Outcome OTO - NOTNLM OT - Cardiac resynchronization therapy OT - Heart failure OT - Implantable cardioverter-defibrillator OT - Mortality predictors OT - Upgrade from cardioverter-defibrillator to resynchronization therapy device EDAT- 2020/12/02 06:00 MHDA- 2021/07/27 06:00 CRDT- 2020/12/01 06:01 PHST- 2020/05/18 00:00 [received] PHST- 2020/10/17 00:00 [accepted] PHST- 2020/12/02 06:00 [pubmed] PHST- 2021/07/27 06:00 [medline] PHST- 2020/12/01 06:01 [entrez] AID - 6012922 [pii] AID - 10.1093/europace/euaa339 [doi] PST - ppublish SO - Europace. 2021 Jan 27;23(1):113-122. doi: 10.1093/europace/euaa339.