title: Cardiac resynchronization therapy improves renal function in human heart failure with reduced glomerular filtration rate.
abstract: BACKGROUND
  Renal dysfunction is an important independent prognostic factor in heart failure (HF). Cardiac resynchronization therapy (CRT) improves functional status and left ventricular (LV) function in HF patients with ventricular dyssynchrony, but the impact of CRT on renal function is less defined. We hypothesized that CRT would improve glomerular filtration rate as estimated by the abbreviated Modification of Diet in Renal Disease equation (eGFR).
  
  
  RESULTS
  The Multicenter InSync Randomized Clinical Evaluation (MIRACLE) study evaluated CRT in HF patients with NYHA Class III-IV, ejection fraction <or=35%, and QRS >or=130 ms. Patients were evaluated before and 6 months after randomization to control (n = 225) or CRT (n = 228). Patients were categorized according to their baseline eGFR: >or=90 (category A), 60 <or=eGFR <90 (category B), and 30 <or=eGFR <60 (category C) mL/min per 1.73 m(2). CRT improved LV function in all categories. Compared with control, CRT increased eGFR (-2.4 +/- 1.2 vs. +2.7 +/- 1.2 mL/min per 1.73 m(2); P = .003) and reduced blood urea nitrogen (+6.4 +/- 2.4 vs. -1.1 +/- 1.5 mg/mL; P = .008) in category C, whereas no differences were observed in categories A and B.
  
  
  CONCLUSIONS
  CRT increased eGFR and reduced blood urea nitrogen in HF patients with moderately reduced baseline eGFR. By improving cardiac function, CRT can indirectly improve renal function, underscoring the importance of cardiorenal interaction and providing another mechanism for the beneficial effects of CRT.
authors: Cardiorenal Research Laboratory, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors: Guido
authors: G
authors: Boerrigter
authors: Lisa C
authors: LC
authors: Costello-Boerrigter
authors: William T
authors: WT
authors: Abraham
authors: Martin G St John
authors: MG
authors: Sutton
authors: Denise M
authors: DM
authors: Heublein
authors: Kristin M
authors: KM
authors: Kruger
authors: Michael R S
authors: MR
authors: Hill
authors: Peter A
authors: PA
authors: McCullough
authors: John C
authors: JC
authors: Burnett
mesh_terms: D009320:Atrial Natriuretic Factor / Q000097:blood; D001806:Blood Urea Nitrogen; D002303:Cardiac Output, Low / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000097:blood / Q000628:therapy*; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000503:physiopathology; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010919:Placebos; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D006454:Hemoglobins; D010919:Placebos; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D003404:Creatinine