Prognostic value of renal function in patients with cardiac resynchronization therapy.
BACKGROUND
Renal insufficiency is prevalent in patients with heart failure and indicates poor prognosis. We examine (i) the relationship between left ventricular (LV) reverse remodeling (RR) and renal function and (ii) the prognostic value of renal function in patients receiving cardiac resynchronization therapy (CRT).


METHODS
The relationship between LV-RR, defined as a 10% reduction in LV end-systolic volume, and renal function was examined in 85 consecutive patients receiving CRT. Echocardiographic assessment and renal function tests were performed before and 3 months after CRT. All-cause mortality and the composite of mortality or heart failure hospitalization between those with preserved or deteriorated renal function at 3 months were assessed by Kaplan Meier analysis.


RESULTS
There was a slight improvement in glomerular filtration rate (GFR) in those with LV-RR (n=44; 51.7+/-20.4 vs. 54.2+/-19.1 ml/min/1.73 m2; p=0.024) while a significant deterioration (n=41; 61.9+/-17 vs. 48.8+/-13.0 ml/min/1.73 m2; p<0.001) was observed in those without LV-RR. The change (Delta) in GFR was significantly correlated with DeltaLV end-systolic/diastolic volumes and DeltaLV ejection fraction. After follow up of 856.4+/-576.8 days, patients with preserved renal function had significant lower all-cause mortality (log rank chi2=4.82, p=0.029) and the composite endpoints (log rank chi2=5.04, p=0.025).


CONCLUSIONS
Preservation of renal function was observed in patients with systolic heart failure and renal insufficiency responding to CRT and provided prognostic information. A rapid decline in renal function after CRT was associated with worse clinical outcomes.
Fung
Jeffrey W H
JW
Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China. jwhfung@cuhk.edu.hk
Szeto
Cheuk C
CC
Chan
Joseph Y S
JY
Zhang
Qing
Q
Chan
Hamish C K
HC
Yip
Gabriel W K
GW
Yu
Cheuk M
CM
D000368:Aged; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*