Abstract 13594: Cardiac Resynchronization Therapy (CRT) in Dialysis Dependent Heart Failure Patients
Introduction CRT is often deferred in dialysis dependant patients because of a perceived lack of benefit. The effects of CRT on dialysis patients have not been well characterized, however.
Methods We conducted a case control study to assess outcomes of dialysis patients undergoing CRT. Cases were identified through query of the electronic medical records for all individuals who have undergone a CRT procedure at our institution. Two controls were selected for each case and were matched for age, gender, bundle branch morphology, diabetes mellitus, cardiomyopathy etiology, beta-blocker, and ACE/ARB use. Baseline and 6 month echocardiograms were assessed for evidence of reverse remodeling. Primary endpoints included 3-year all-cause mortality and all-cause hospitalization.
Results Fifteen cases and 30 controls undergoing CRT for standard indications were identified with the following characteristics: mean EF 24±7%, QRS 168±30ms, 56% LBBB, 20% female. There were no differences in baseline characteristics except that controls were more likely to use diuretics and have paroxysmal atrial fibrillation. The mean creatinine of controls was 1.7±0.8mg/dl. Cases did not have a significant change in EF or LV dimensions at follow-up. In contrast, controls had a 9.5±9.4% increase in EF (p<0.001), a 5.4±6.1mm decrease in LV end systolic diameter (p=0.002), and a 4.3±5.8mm decrease in LV end diastolic diameter (p=0.008). Two cases demonstrated a ≥5% increase in EF. Cases had increased 3-year mortality compared to controls (73% vs. 45%, p=0.015, Figure) with a 2.5x increase risk of death (HR 2.51, p = 0.031) and an increased incidence of 3-year all-cause hospitalizations (100% vs. 74%, p=0.022).
Conclusions Dialysis dependant patients undergoing CRT have poor echocardiographic response and increased risk of death and all-cause hospitalizations compared to matched controls. Further studies are needed to identify which dialysis dependant patients benefit from CRT.
- © 2012 by American Heart Association, Inc.