title: Independent predictors of mortality in patients with advanced heart failure treated by cardiac resynchronization therapy.
abstract: OBJECTIVE
  The current study includes all consecutive patients with advanced heart failure and cardiac resynchronization therapy (CRT) with an implantable cardioverter defibrillator (ICD) over a 10-year period in a tertiary referral centre. It aims at identifying independent risk factors for mortality during CRT-defibrillator (CRT-D) treatment.
  
  
  RESULTS
  This study includes 239 consecutive patients who had undergone implantation of a CRT-D system (ejection fraction 25.9 ± 8%; 139 patients with ischaemic, 100 patients with non-ischaemic cardiomyopathy). Enrolment took place between 2001 and 2010, resulting in a median follow-up of 43 ± 30 months. During follow-up, 59 patients (25%) died. An impaired baseline kidney function [hazard ratio (HR) 1.98; 95% confidence interval (CI) 1.7-3; P< 0.0001], appropriate ICD therapy during follow-up (HR 2.1; CI 1.1-3.4; P= 0.001), lack of beta-blocker therapy (HR 2.3; CI 1.6-3.8; P= 0.004), and intake of amiodarone (HR 2; CI 1.8-4.1; P< 0.0001) were identified as predictors of overall mortality.
  
  
  CONCLUSIONS
  This study demonstrates the benefit of beta-blocker therapy also in patients on long-term CRT-D treatment. It confirms the prognostic significance of impaired renal function and the occurrence of appropriate ICD therapies also in CRT-D patients. It argues for an intensified follow-up regimen and adjustment of heart failure treatment whenever these prognostic markers are identified in a patient treated with CRT-D.
authors.affiliation: Department of Medicine-Cardiology, University of Bonn, Freud-Str 25, 53105 Bonn, Germany. jens.kreuz@ukb.uni-bonn.de
authors.forename: Jens
authors.initials: J
authors.lastname: Kreuz
authors.forename: Fritz
authors.initials: F
authors.lastname: Horlbeck
authors.forename: Markus
authors.initials: M
authors.lastname: Linhart
authors.forename: Fritz
authors.initials: F
authors.lastname: Mellert
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.forename: Jan
authors.initials: J
authors.lastname: Schrickel
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Jörg Otto
authors.initials: JO
authors.lastname: Schwab
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000638:Amiodarone