title: Comorbidity significantly affects clinical outcome after cardiac resynchronization therapy regardless of ventricular remodeling.
abstract: BACKGROUND
  The influence of comorbid conditions on ventricular remodeling, functional status, and clinical outcome after cardiac resynchronization therapy (CRT) is insufficiently elucidated.
  
  
  RESULTS
  The influence of different comorbid conditions on left ventricular remodeling, improvement in New York Heart Association (NYHA) functional class, hospitalizations for heart failure, and all-cause mortality after CRT implantation was analyzed in 172 consecutive patients (mean age 71 ± 9 y), implanted from October 2008 to April 2011 in a single tertiary care hospital. During mean follow-up of 18 ± 9 months, 21 patients died and 57 were admitted for heart failure. Left ventricular remodeling and improvement in NYHA functional class were independent from comorbidity burden. However, diabetes mellitus (hazard ratio [HR] 3.45, 95% confidence interval [CI] 1.24-9.65) and chronic kidney disease (HR 3.11, 95% CI 1.10-8.81) were predictors of all-cause mortality, and the presence of chronic obstructive pulmonary disease (HR 1.89, 95% CI 1.02-3.53) was independently associated with heart failure admissions. Importantly, those 3 comorbid conditions had an additive negative impact on survival and heart failure admissions, even in patients with reverse left ventricular remodeling.
  
  
  CONCLUSIONS
  Reverse ventricular remodeling and improvement in functional status after CRT implantation are independent from comorbidity burden. However, comorbid conditions remain important predictors of all-cause mortality and heart failure admissions.
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Frederik H
authors.initials: FH
authors.lastname: Verbrugge
authors.forename: Matthias
authors.initials: M
authors.lastname: Dupont
authors.forename: Maximo
authors.initials: M
authors.lastname: Rivero-Ayerza
authors.forename: Philippe
authors.initials: P
authors.lastname: de Vusser
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Herendael
authors.forename: Jan
authors.initials: J
authors.lastname: Vercammen
authors.forename: Linda
authors.initials: L
authors.lastname: Jacobs
authors.forename: David
authors.initials: D
authors.lastname: Verhaert
authors.forename: Pieter
authors.initials: P
authors.lastname: Vandervoort
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mullens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*