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Predictors of long-term mortality with cardiac resynchronization therapy in mild heart failure patients with left bundle branch block.

Abstract：

BACKGROUND:Cardiac resynchronization therapy (CRT) is highly beneficial in patients with heart failure (HF) and left bundle branch block (LBBB); however, up to 30% of patients in this selected group are nonresponders. HYPOTHESIS:We hypothesized that clinical and echocardiographic variables can be used to develop a simple mortality risk stratification score in CRT. METHODS:Best-subsets proportional-hazards regression analysis was used to develop a simple clinical risk score for all-cause mortality in 756 patients with LBBB allocated to the CRT with defibrillator (CRT-D) group enrolled in the multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy. The score was used to assess the mortality risk within the CRT-D group and the associations with mortality reduction with CRT-D vs implantable cardioverter defibrillator (ICD) in each risk category. RESULTS:Four clinical variables comprised the risk score: age ≥ 65, creatinine ≥ 1.4 mg/dL, history of coronary artery bypass graft, and left ventricular ejection fraction (LVEF) < 26%. Every 1 point increase in the score was associated with 2-fold increased mortality within the CRT-D arm (P < 0.001). CRT-D was associated with mortality reduction as compared with ICD only in patients with moderate risk: score 0 (HR = 0.80, P = 0.615), score 1 (HR = 0.54, P = 0.019), score 2 (HR = 0.54, P = 0.016), score 3-4 risk factors (HR = 1.08, P = 0.811); however, the device by score interaction was not significant (P = 0.306). The score was also significantly predictive of left ventricular reverse remodeling (P < 0.001). CONCLUSIONS:Four clinical variables can be used for improved mortality risk stratification in mild HF patients with LBBB implanted with CRT-D.

journal_name

Clin Cardiol

journal_title

Clinical cardiology

authors

Biton Y,Costa J,Zareba W,Baman JR,Goldenberg I,McNitt S,Solomon SD,Polonsky B,Kutyifa V

doi

10.1002/clc.23058

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

1358-1366

issue

eissn

0160-9289

issn

1932-8737

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Predictors of long-term mortality with cardiac resynchronization therapy in mild heart failure patients with left bundle branch block.