Abstract 11659: Mechanical Dyssynchrony is Predictive of Clinical Outcomes After Cardiac Resynchronization Therapy in Patients with Chronic Kidney Disease
Background: Although cardiac resynchronization therapy (CRT) benefits many heart failure (HF) patients, about 1/3 are non-responders. Chronic kidney disease (CKD) has been identified as an important clinical risk factor for non-response to CRT, but factors associated with non-response in CKD patients are unclear.
Objective: To test the hypothesis that mechanical dyssynchrony is particularly predictive of clinical outcomes after CRT in CKD patients.
Methods: We studied 324 NYHA III/IV heart failure patients for CRT (all EF ≤ 35% and QRS ≥120ms): 137 (42%) had CKD defined as glomerular filtration rate (GFR) <60 ml/min/1.73 m2. Baseline dyssynchrony was assessed by speckle tracking radial strain (anteroseptum to posterior wall delay ≥ 130ms considered significant). Pre-specified end-points were death, heart transplant or left ventricular assist device (LVAD) over 2.5 years. Reverse remodeling was defined as ≥10% relative decrease in end systolic volume.
Results: After CRT there were 73 events in 324 patients: 54 deaths, 10 transplants and 9 LVADs. Overall, patients without CKD had a more favorable long term survival compared to CKD patients (p=0.0001). However, CKD patients with baseline dyssynchrony had a much more favorable event free survival when compared to CKD patients without baseline dyssynchrony (p=0.002), with an absolute risk reduction after CRT of 21% vs. 11% in non-CKD patients. Furthermore, CKD patients with baseline dyssynchrony had a similar reverse remodeling rate to non-CKD patients (70% vs.63% p=ns) and a significantly higher rate than CKD patients without baseline dyssynchrony (70% vs.42% p=0.01).
Conclusion: Although clinical outcomes after CRT in CKD patients were less favorable overall than patients without CKD, baseline dyssynchrony in CKD patients was particularly predictive of event free survival and reverse remodeling rate. These observations add important prognostic information to CRT patients with CKD
- © 2012 by American Heart Association, Inc.