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Title: Comorbidity Significantly Affects Clinical Outcome After Cardiac Resynchronization Therapy Regardless of Ventricular Remodeling
Authors: VERBRUGGE, Frederik 
DUPONT, Matthias 
Rivero-Ayerza, Maximo
DE VUSSER, Philip 
Van Herendael, Hugo
Vercammen, Jan
Jacobs, Linda
Verhaert, David
MULLENS, Wilfried 
Tang, W. H. Wilson
Issue Date: 2012
Source: JOURNAL OF CARDIAC FAILURE, 18 (11), p. 845-853
Abstract: Background: The influence of comorbid conditions on ventricular remodeling, functional status, and clinical outcome after cardiac resynchronization therapy (CRT) is insufficiently elucidated. Methods and Results: The influence of different comorbid conditions on left ventricular remodeling, improvement in New York Heart Association (NYHA) functional class, hospitalizations for heart failure, and all-cause mortality after CRT implantation was analyzed in 172 consecutive patients (mean age 71 +/- 9 y), implanted from October 2008 to April 2011 in a single tertiary care hospital. During mean follow-up of 18 +/- 9 months, 21 patients died and 57 were admitted for heart failure. Left ventricular remodeling and improvement in NYHA functional class were independent from comorbidity burden. However, diabetes mellitus (hazard ratio [HR] 3.45, 95% confidence interval [CI] 1.24-9.65) and chronic kidney disease (HR 3.11, 95% CI 1.10-8.81) were predictors of all-cause mortality, and the presence of chronic obstructive pulmonary disease (HR 1.89, 95% Cl 1.02-3.53) was independently associated with heart failure admissions. Importantly, those 3 comorbid conditions had an additive negative impact on survival and heart failure admissions, even in patients with reverse left ventricular remodeling. Conclusions: Reverse ventricular remodeling and improvement in functional status after CRT implantation are independent from comorbidity burden. However, comorbid conditions remain important predictors of all-cause mortality and heart failure admissions.
Notes: Mullens, W (reprint author),[Verbrugge, Frederik H.; Dupont, Matthias; Rivero-Ayerza, Maximo; De Vusser, Philippe; Van Herendael, Hugo; Vercammen, Jan; Jacobs, Linda; Verhaert, David; Vandervoort, Pieter; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, B-3600 Genk, Belgium. [Verbrugge, Frederik H.] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Vandervoort, Pieter; Tang, W. H. Wilson; Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepetzbeek, Belgium. [Dupont, Matthias; Verhaert, David] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH 44106 USA.
Keywords: Biventricular pacing; frailty; treatment response; adverse events;Cardiac & Cardiovascular Systems; biventricular pacing; frailty; treatment response; adverse events
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ISSN: 1071-9164
e-ISSN: 1532-8414
DOI: 10.1016/j.cardfail.2012.09.003
ISI #: 000311178700006
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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