Impaired Renal Function Is Associated With Echocardiographic Nonresponse and Poor Prognosis After Cardiac Resynchronization Therapy

作者：Van Bommel Rutger J; Mollema Sjoerd A; Borleffs Jan Willem; Bertini Matteo; Ypenburg Claudia; Marsan Nina Ajmone; Delgado Victoria; Van Der Wall Ernst E; Schalij Martin J; Bax Jeroen J^*

来源：Journal of the American College of Cardiology, 2011, 57(5): 549-555.

DOI：10.1016/j.jacc.2010.06.060

• cardiac resynchronization therapy
• heart failure
• outcome
• renal function

Objectives Aims of this study were to investigate the effect of renal function on left ventricular (LV) reverse remodeling and long-term outcome after cardiac resynchronization therapy (CRT), and to explore the relation between LV reverse remodeling and changes in renal function at 6-month follow-up.
Background Renal insufficiency is highly prevalent in heart failure patients, including patients eligible for CRT, and is associated with poor prognosis.
Methods The study comprised 490 patients undergoing CRT. Response to CRT was defined as a decrease in LV end-systolic volume >= 15% at 6-month follow-up. Primary end point during long-term follow-up was all-cause mortality.
Results At baseline, mean estimated glomerular filtration rate (eGFR) was 70 +/- 28 ml/min/1.73 m(2). At 6-month follow-up, 263 patients (54%) demonstrated response to CRT. Responders had an eGFR of 74 +/- 26 ml/min/1.73 m(2) versus 64 +/- 28 ml/min/1.73 m(2) in nonresponders (p < 0.001). During long-term follow-up, patients with an eGFR <60 ml/min/1.73 m(2) had higher mortality than patients with an eGFR of 60 to 90 ml/min/1.73 m(2) or an eGFR >90 ml/min/1.73 m(2) (p < 0.001). Finally, responders to CRT had preservation of renal Delta eGFR -0.6), whereas nonresponders had a slight worsening in renal Delta eGFR -4.7, p < 0.05).
Conclusions Impaired renal function in CRT candidates is associated with nonresponse during 6-month follow-up. Additionally, patients with impaired renal function have worse long-term survival after CRT. Response to CRT results in preservation of renal function.

• 出版日期2011-2-1