The Impact of Age, Gender, and Heart Failure Etiology on the Outcome of Cardiac Resynchronization Therapy

The cardiorenal syndrome (CRS) is a complex clinical syndrome in which dysfunction of either the heart or the kidneys affects the functioning of the other organ system. Many therapies used in heart failure have further detrimental effects on renal function. Cardiac resynchronization therapy (CRT) is a relatively new form of device therapy that reduces morbidity and mortality in patients with heart failure. This review will discuss the effects of CRT on renal function in patients with CRS, the impact of baseline renal function on response to CRT, and potential risks associated with CRT in this unique population.

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The impact of gender difference on clinical and echocardiographic outcomes in patients with heart failure after cardiac resynchronization therapy: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0176248 ◽

2017 ◽

Vol 12 (4) ◽

pp. e0176248 ◽

Cited By ~ 7

Author(s):

Fa-Hui Yin ◽

Chun-Lei Fan ◽

Ya-Ya Guo ◽

Hai Zhu ◽

Zhi-Lu Wang

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Gender Difference ◽

Cardiac Resynchronization Therapy ◽

Meta Analysis ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Patients With Heart Failure ◽

The Impact

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Outcomes of cardiac resynchronization therapy with or without a defibrillator in patients with nonischemic cardiomyopathy in Korea: a nationwide cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0802 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P.S Yang ◽

Y Kang ◽

H.D Park ◽

J.H Sung ◽

B Joung

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Cardiac Death ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Heart Failure Hospitalization ◽

Asian Patients ◽

Kaplan Meier ◽

Cardiac Resynchronization Therapy Devices ◽

The Impact

Abstract Background Randomized control trials comparing the effectiveness of cardiac resynchronization therapy devices, with (CRT-D) or without (CRT-P) a defibrillator, are scarce in heart failure patients. Patients with nonischemic dilated cardiomyopathy (NICM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy. In addition, NICM has been identified as a predictor of positive response to CRT. The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT in Korean patients with NICM. Methods During the period from January 1, 2008 to December 31, 2017, 533 NICM patients (mean age, 65.7±12.2 years, male 53.6%) with newly-implanted CRT-P (n=71) or CRT-D (n=462) who were aged 19 years or older were identified by 50-percents random sampling from the Korean National Health Insurance Service database. Results Compared with patients receiving CRT-P, those receiving CRT-D were younger (65.3±12.3 vs. 68.3±11.6 years, p=0.038), more likely to be male (56.1% vs. 38.0%, p=0.005), and have an admission history of congestive heart failure (93.9% vs. 87.3%, p=0.041). Over the mean follow-up period of 21 months,114 cases in the CRT-D group and 24 cases in the CRT-P group died, with annualized mortality rates of 14.9 and 17.2 per 100 person-years, respectively. Kaplan-Meier estimates of event-free survival showed that there was no difference in mortality between CRT-D and CRT-P groups (p=0.343). In multivariate analysis, factors associated with mortality were chronic kidney disease, atrial fibrillation, and older age. With regard to death or heart failure hospitalization, heart failure death, and non-cardiac death, there were no difference between the two groups. Conclusions Among Asian patients with NICM with indications for CRT, death, death or heart failure hospitalization, heart failure death, and non-cardiac death were not different between CRT-D and CRT-P groups. Funding Acknowledgement Type of funding source: None

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Abstract 5895: The Impact of Response to Cardiac Resynchronization Therapy on Ventricular Arrhythmic Events

Circulation ◽

10.1161/circ.118.suppl_18.s_1024-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Kenji Ando ◽

Yoshimitsu Soga ◽

Takeshi Arita ◽

Shinichi Shirai ◽

Masahiko Goya ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Nyha Class ◽

Survival Rates ◽

Cardiac Resynchronization ◽

Rank Test ◽

Resynchronization Therapy ◽

Event Free Survival ◽

Free Survival ◽

The Impact

Background: It’s well known that cardiac resynchronization therapy (CRT) is effective to reduce heart failure hospitalization. However, the impact of response to CRT on ventricular arrhythmic events is not well established. Methods: We investigated 216 pts received CRT in two institutions (age 69.3+/−10.8 years, NYHA class 3.1+/−0.5, LVEF 25.8+/−7.4%, LVEDD 62.1+/−8.3mm, pre QRS duration 158+/−32ms, AF 19.4%, ischemic heart disease 33.3%, CRT-D 51.3%) and divided into two groups, Responders (n=145, 67.1%) and Non-responders (n=71, 32.9%). CRT responder was defined as improvement of LVEF > or =5%, or reduction of LVEDD > or = 5mm at 3–6 month echo data. Long-term ventricular arrhythmic events (ventricular tachycardia: VT, ventricular fibrillation: VF and sudden cardiac death: SCD) were obtained. Kaplan-Meier curve were draw and Long-Rank test was used to compare event rates of two groups. Results: Mean follow up periods was 19.3 +/−12.7 months. Event free survival rates from ventricular arrhythmic events (VT, VF and SCD) were all significantly higher in Responders compared to Non-responders (VT: 89.2% vs. 77.8% at 2 year, Log-rank p=0.031, VF: 99.2% vs. 89.9% at 2 year, Log-rank p=0.0031, SCD: 98.6% vs. 89.2% at 2 year, Log-rank p=0.0038) and event free survival rate from combined VT, VF and SCD was also significantly higher in Responders (87.8% vs. 76.5% at 2 year, Log-rank p=0.0013). Conclusion: Response to CRT seems to reduce not only heart failure events, but also ventricular arrhythmic events. Figure: Adverse events in new onset AF vs no AF

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