Abstract 9371: Diuretic Use and the Benefit of Cardiac Resynchronization Therapy to Prevent Heart Failure and Death: Secondary Analysis of Data from MADIT-CRT.
MADIT-CRT demonstrated a reduction in the composite endpoint of heart failure (HF) or death with CRT-D vs. ICD-only therapy in patients with NYHA class I-II, ejection fraction <0.30, and QRS >130ms. Additional predictive variables would aid in selecting patients for preventive CRT-D. We hypothesized that diuretic use at study enrollment might identify patients with more advanced cardiac impairment and incipient HF and thus greater potential for reduction in later overt HF or death with CRT-D. At baseline, 1228 patients were diuretic users and 592 were diuretic non-users. Kaplan-Meier graphs are shown for the two subgroups. Diuretic users showed a relatively high probability of overt HF or death with ICD alone plus a large, highly significant reduction in the risk of this end point with CRT-D therapy. Nonusers had fewer of these events with ICD and modest reduction of borderline statistical significance with CRT-D. As anticipated, the predictive information derived from diuretic use was not unique: when adjusted for imbalances in relevant baseline characteristics (e.g., serum creatinine), diuretic users and non-users experienced similar benefit from CRT-D therapy.
Conclusion: in MADIT-CRT, the physician's pre-enrollment decision to use diuretics discriminated between a subgroup achieving a strikingly significant benefit from CRT-D therapy and one receiving little likelihood of benefit. This finding may aid in selecting optimal management for patients resembling MADIT-CRT enrollees.
- © 2011 by American Heart Association, Inc.