Abstract 12200: Comorbidity Significantly Affects Clinical Outcome after Cardiac Resynchronization Therapy Irrespectively of Ventricular Remodeling
Objective: To assess the impact of different comorbid conditions on ventricular remodeling, functional capacity and clinical outcome after cardiac resynchronization therapy (CRT).
Methods: In 172 consecutive CRT patients (71 ± 9 years), the impact of obesity, diabetes mellitus, hypercholesterolemia, history of hypertension, chronic kidney disease, anemia, chronic obstructive pulmonary disease (COPD) and atrial fibrillation on reverse left ventricular remodeling, improvement in New York Heart Association (NYHA) functional class, heart failure admissions and all-cause mortality, was analyzed.
Results: During mean follow up of 18 ± 9 months, 21 patients died and 57 were admitted for heart failure. Reverse left ventricular remodeling and improvement in NYHA functional class were independent from comorbidity burden. However, diabetes mellitus (HR 3.33, 95 % CI 1.37 - 8.08) and chronic kidney disease (HR 2.96, 95 % CI 1.19 - 7.37) were predictors of all-cause mortality, while history of hypertension (HR 3.69, 95 % CI 1.30 - 10.50); COPD (HR 1.93, 95 % CI 1.06 - 3.54) and chronic kidney disease (HR 1.81, 95 % CI 1.00-3.26) were associated with heart failure admissions. Importantly, these 4 comorbidities had additive negative impact on adverse outcome, even in patients with reverse ventricular remodeling (Figure).
Conclusions: Reverse left ventricular remodeling and improvement in NYHA functional class after CRT are independent from comorbidity burden, which remains however an important predictor of all-cause mortality and heart failure admissions.
- © 2012 by American Heart Association, Inc.