title: Effectiveness of cardiac resynchronization therapy with defibrillator in at-risk black and white cardiac patients.
abstract: BACKGROUND
  There are limited data regarding racial differences in response to cardiac resynchronization therapy with defibrillator (CRT-D).
  
  
  METHODS
  We assessed the effectiveness of CRT-D, as compared to implantable cardioverter defibrillator (ICD) therapy alone, in reducing the risk of heart failure (HF) or death and changes in cardiac volumes among 1638 (90%) white patients and 143 (8%) black patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT).
  
  
  RESULTS
  Enrolled black patients displayed a higher frequency of diabetes mellitus, treated hypertension, higher creatinine levels, and a lower distance walked in the baseline 6-minute walk test. Kaplan-Meier survival analysis showed that at 3 years of follow-up the cumulative probability of HF or death was higher among blacks (29%) as compared with whites (22%; P = 0.05). Both black and white patients experienced similar and pronounced reductions in cardiac volumes with CRT-D therapy (all P values for comparison between the two groups >0.10). Risk reduction conferred by CRT-D therapy as not significantly different between blacks and whites (hazard ratio = 0.78 and 0.60, respectively; P for the difference = 0.44). However, possibly due to sample size limitations the CRT-D versus ICD only adjusted risk for HF/death in blacks was not statistically significant.
  
  
  CONCLUSIONS
  Black patients in MADIT-CRT experienced increased risk of HF or death as compared with whites, but displayed a similar magnitude echocardiographic response to CRT-D. These findings suggest that cardiac resynchronization therapy may be an effective therapeutic modality in black patients. However, further studies are needed to assess the clinical response to CRT-D in this high-risk population.
authors.affiliation: Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA.
authors.forename: Meena
authors.initials: M
authors.lastname: Elanchenny
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aktas
authors.forename: Slava
authors.initials: S
authors.lastname: Polonsky
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
mesh_terms: D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002306:Cardiac Volume; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D003920:Diabetes Mellitus; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006333:Heart Failure / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000150:complications; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*