Abstract 3086: Chronic Renal Insufficiency is an Independent Predictor of Ventricular Arrhythmias and All-Cause Mortality in Ischemic (But Not Non-Ischemic) Cardiomyopathy Patients
Background: Chronic renal insufficiency (CRI) has been associated with increased risk of cardiovascular morbidity and mortality. However, little is known about the relationship between CRI and ventricular arrhythmias, specifically ventricular tachycardia (VT) in patients with implantable cardioverter-defibrillators (ICDs). Aim: to investigate whether there was an association between CRI (as documented by serum creatinine levels ≥ 1.5mg/dl) and increased risk of VT and all-cause mortality in ICD patients.
Methods: A retrospective study of ICD patients followed within a 2.5 year period in our clinic was conducted. A total of 336 ICD patients were identified, including 236 ischemic cardiomyopathy (ICMP) patients. The presence of CRI, occurrence of spontaneous VT, and mortality were recorded. ICMP was defined as the presence of coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) 30% or less, while non-ICMP (NICMP) was defined as LVEF 30% or less in the absence of CAD.
Results: Despite no significant difference in CAD and VT occurrence between the CRI and non-CRI groups in the overall population, there was a significantly higher mortality rate in the CRI group (P<0.0001). Among ICMP patients (n=236), there was a higher incidence of VT and mortality in the CRI group. An association between CRI and VT (p= 0.045) was noted by chi-square analysis and stepwise logistic regression analysis revealed that CRI was a significant independent predictor of VT in ICMP patients (p=0.03; O.R. 1.95, 95% CI = 1.06–3.59), as well as a significant mortality predictor (p<0.0001). In the NICMP group (n=39, mean age 61.4 years), there was no significant difference between the CRI and non-CRI subgroups in VT occurrence or mortality (p >0.05). CRI was not a significant predictor of VT or mortality by logistic regression analysis.
Conclusions: CRI is a significant independent predictor of spontaneous VT and mortality in ICMP patients and its association with VT may partially account for the increased cardiovascular morbidity and mortality noted in patients with renal insufficiency. Furthermore, CRI may be clinically useful in risk-stratification to help identify the subset of patients who would most likely benefit from prophylactic ICDs.