| Objective:To observe the incidence and investigate the potential risk factors of non-response to cardiac resynchronization therapy (CRT) as well as adverse clinical outcome in patients with advanced chronic heart failure (HF).Methods:The study included a total of 247 CRT patients from January 1999 and December 2013 in our hospital. The clinical characteristics, disease history, laboratory examination, electrocardiographic examination, chest X-ray, cardiac echocardiography and drug treatment at baseline were collected. Patients were classified as responders to CRT in terms of improvement in NYHA class by≥1 combined with an absolute increase≥5% in LVEF at 6-month follow-up. Patients who did not meet above criteria, or died, underwent heart transplantation or hospitalized for HF within 6-month were regarded as non-responders. The primary endpoint events included all-cause mortality and heart failure readmission. Univariate and multivariate binary logistic regression analysis was utilized to evaluate the relationship between baseline characteristics and response to CRT. In the meantime, the risk factors for all-cause mortality and the combined endpoint of all-cause mortality or HF hospitalizations were determined by using univariate and multivariate Cox proportional hazards analysis.Results:Of 247 patients enrolled in our study,166 (67.2%) were male. The average age was 59.2±10.7 years. Patients had severely depressed cardiac function with a mean LVEF of 28±7%, and the LVEDD was 71.0± 9.0 mm and NYHA class was 3.2 ±0.4. Among of them, there were 175 patients with dilated cardiomyopathy and 60 patients with ischemic cardiomyopathy. A total of 200 patients experienced LBBB and the average QRS duration was 158.0±20.0 ms. During 6-month follow-up, the rate of response to CRT was 63.8% and non-response rate was 36.2%。During a mean follow-up of 29.4± 31.2 months, there were 33 deaths (13.4%), of which 25 were HF-related deaths, 5 were sudden deaths and 3 patients were non-cardiac cause. In addition, 4 patients (1.6%) underwent heart transplantations and 70 patients (28.3%) were hospitalized for worsening heart failure. Multivariate logistic regression analysis showed that ischaemic heart disease (IHD) and left ventricle (LV) lead in anterior segment at baseline were identified as independent predictors of CRT non-response (P<0.05), QRS duration prolongation, left bundle branch block (LBBB), and elevated body index (BMI) and estimated glomerular filtration rate (eGFR) at baseline were identified as independent predictors of CRT response (P<0.05). Multivariate Cox proportional hazards analysis demonstrated that LBBB, right ventricular end-diastolic diameter (RVEDD), BMI, high-sensitivity C-reactive protein (hsCRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and LV lead in posterior segment at baseline were associated with all-cause mortality (P<0.05). Moreover, BMI, eGFR, serum creatinine (Scr), hsCRP, NT-proBNP and LV lead in posterior segment at baseline were also identified as independent predictors for the combined endpoint of deaths or hear failure hospitalizations (P<0.05)Conclusions:Our study result indicated that the rate of response to CRT was 63.8% and non-response rate was 36.2%. IHD, LV lead in anterior segment, QRS duration, LBBB, BMI and eGFR at baseline were associated with CRT response or non-response. LBBB, RVEDD, BMI, hsCRP, NT-proBNP and LV lead in posterior segment at baseline were associated with all-cause mortality. Furthermore, BMI, eGFR, Scr, hsCRP, NT-proBNP and LV lead in posterior segment at baseline were also identified as independent predictors for the combined endpoint of deaths or hear failure hospitalizations.Objective:The effect of adiposity on the response to cardiac resynchronization therapy (CRT) and long-term outcome in patients undergoing CRT has not been previously reported. This study was to assess the impact of baseline body mass index (BMI) on the cardiac reverse remodeling and prognosis in patients following CRT.Methods:The study designed as a prospectively observational study. A total of 247 CRT patients were included and divided into 4 groups by BMI at baseline from January 1999 and December 2013. Patients were classified as underweight (<18.5 kg/m2), normal weight (18.5 to<24 kg/m2), overweight (24 to<28 kg/m2), and obese (^28 kg/m2). Patients were classified as responders to CRT in terms of improvement in NYHA class by  combined with an absolute increase≥5% in LVEF at 6-month follow-up. The primary endpoint events included all-cause mortality and heart failure readmission. The risk factors for all-cause mortality and the combined endpoint of all-cause mortality or HF hospitalizations were determined by using univariate and multivariate Cox proportional hazards analyses.Results:All the patients had an average BMI of 24.4±3.9 kg/m2, ranging from 13.7 to 39.4 kg/m2. During 6-month follow-up, overweight and obese patients (BMI 24 to<28 kg/m2 and≥28 kg/m2, respectively) were inclined to show better clinical and echocardiographic improvements (P<0.05) as well as higher response rate (P<0.001) than underweight and normal weight patients (BMI<18.5 kg/m2 and 18.5 to<24 kg/m2, respectively). During the long-term follow-up, patients with overweight and obese had lower all-cause mortality (P=0.015) and the combined endpoint of deaths or HF hospitalizations (P=0.001) than those with underweight and normal weight. Compared with normal weight patients, underweight patients showed a 1.17-fold increase in the risk of the combined endpoint events whereas overweight and obese patients experienced a reduction in the risk of deaths (69% and 61%, respectively) and the combined endpoint events (52% and 28%, respectively).Conclusions:Patients with obesity and overweight were likely to drive more benefit from CRT. A lower BMI was independently associated with worse clinical outcome in CRT patients.Background and objective:Renal insufficiency (RI) was significantly associated with clinical prognosis in patients with heart failurebut direct evidences on the relation between renal function and clinical outcome in patients receiving cardiac resynchronization therapy (CRT) were limited. The aim of current study was to systematically evaluate the association of baseline and 6-month renal function with cardiac reverse remodeling and long-term outcome after CRT.Methods:We retrospectively evaluated 190 consecutive patients who underwent CRT. Renal function tests, echocardiographic measurement and clinical parameters at baseline and after 6 months of CRT were performed. Primary endpoint events included all-cause mortality and unplanned hospitalizations for heart failure. The risk factors for the combined endpoint of all-cause mortality or HF hospitalizations were determined by using univariate and multivariate Cox proportional hazards analyses.Results:At baseline, all the patients had an average estimated glomerular filtration rate (eGFR) of 70.0±25.4 ml/min/1.73m2. Patients were classified as underweight normal or increased eGFR (≥90 ml/min/1.73m2, n=37), normal weight (60 to<90 ml/min/1.73m2, n=86), overweight (24 to 28 kg/m2), and moderately to severely reduced eGFR (<60 ml/min/1.73m2, n=67). Compared with normal renal function or mild RI[(eGFR)>60 ml/min/1.73m2], moderate to severe RI (eGFR<60 ml/min/1.73m2) exerted a negative influence on cardiac reverse remodeling parameters. At 6-month follow-up,114(60.0%) patients were classified as responders and showed significant renal function improvement whereas renal function deteriorated in non-responders and subsequently 41(25.6%) patients developed worsening renal function (WRF). During the mean follow-up of 24.3±17.1 months, both patients with baseline eGFR<60 ml/min/1.73m2 and those with WRF experienced worse event-free survival (P<0.001 and P=0.001, respectively). In multivariate Cox analysis, baseline eGFR as well as WRF after CRT strongly predicted the combined endpoint of deaths or HF-related hospitalizations (HR:0.98; 95% CI:0.97-0.99, P=0.028 and HR:2.36; 95% CI:1.14-4.88, P=0.020, respectively)Conclusions:This analysis identified that baseline eGFR as well as WRF after CRT were found to be independent determinants of the combined endpoints of all-cause mortality and HF-related hospitalizations in CRT recipients.
|
PDF Full Text Request