Abstract 14851: Predictors of Death Within Six Months of Cardiac Resynchronisation Therapy
Purpose Although predictors of poor long-term outcome following cardiac resychronization therapy (CRT) have been identified, contributors to early mortality after CRT are poorly characterized. The aim of this study was to identify predictors of all-cause mortality within 6 months of CRT.
Methods A total of 889 consecutive CRT recipients were included. Patients underwent clinical evaluation and transthoracic echocardiography before CRT implantation. Patients were followed prospectively for at least 6 months following device insertion. Long-term follow-up to determine the incidence of death was available.
Results A total of 54 (6%) patients died within 6 months of CRT. Compared with those surviving more than 6 months following CRT, those dying early featured more advanced heart failure symptoms by New York Heart Association class (p<0.001), lower 6-minute walk distance (229±110m v. 311±119m, p<0.001), greater diuretic use (96% v. 83%, p=0.009), lower estimated glomerular filtration rate (eGFR 56±26mL/min v. 71±33mL/min, p<0.001) and hemoglobin concentration (Hb 7.9±1.2mmol/L v. 8.3±1.0mmol/L, p<0.001), greater left ventricular (LV) end-systolic volume (191±75mL v. 163±69mL, p=0.007), lower LV ejection fraction (22±8% v. 26±8%, p<0.001), more severe mitral regurgitation (p<0.001) and less LV dyssynchrony (septal-lateral delay 56±44ms v. 72±48ms). Independent predictors of 6-month all-cause mortality among CRT recipients included lower 6-minute walk distance, lower LVEF, greater MR severity, and less LV dyssynchrony (Table).
Conclusions Patients dying early after CRT demonstrate poorer cardiac function and functional capacity compared with those surviving more than 6 months. Importantly, less LV dyssynchrony is notwithstanding an independent predictor of early mortality after CRT. These findings inform risk-benefit in the decision-making process prior to CRT.
- © 2011 by American Heart Association, Inc.