title: Functional response to cardiac resynchronization therapy in patients with renal dysfunction and subsequent long-term mortality.
abstract: BACKGROUND
  Renal dysfunction is associated with increased morbi-mortality in heart failure patients. Data regarding functional and clinical efficacy of cardiac resynchronization therapy (CRT) in this population are limited.
  
  
  RESULTS
  We aimed to evaluate the rate of functional response to CRT in patients with renal dysfunction and its association with long-term mortality. Our study included a total of 179 consecutive patients implanted between 2007 and 2010. The rate of functional response to CRT (defined by a composite score using New York Heart Association functional class, 6-minute walk test, and quality of life) was compared between patients with and without renal dysfunction (defined as eGFR < or ≥60 mL/min/1.73 m(2) ). Survival analysis estimates were constructed according to the Kaplan-Meier method, with results comparison using the log-rank test. During a median follow-up of 4.2 years, 73 patients (40%) died. Patients with low eGFR were older (72 ± 8 years vs. 64 ± 12 years; P < 0.001), and had higher prevalence of ischemic heart disease (75% vs. 53%; P = 0.003). Functional response rates did not differ significantly between patients with and without renal dysfunction (58% and 69%, respectively; P = 0.14). Despite overall higher mortality in patients with low eGFR (53.8% vs. 22.7%; P < 0.001), the presence of functional response at 1 year among patients with renal dysfunction was still independently associated with an improved long-term survival (HR = 0.49 [95%CI: 0.28-0.83]; P = 0.009).
  
  
  CONCLUSIONS
  Functional response to CRT at 1 year does not differ significantly between patients with or without kidney disease, and is an independent predictor of improved long-term survival in patients with renal dysfunction.
authors.affiliation: Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel; Cardiology Department, Clinical Emergency Hospital Bucharest, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bogdan
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
authors.forename: Avi
authors.initials: A
authors.lastname: Sabbag
authors.forename: David
authors.initials: D
authors.lastname: Luria
authors.forename: Osnat
authors.initials: O
authors.lastname: Gurevitz
authors.forename: David
authors.initials: D
authors.lastname: Bar-Lev
authors.forename: Igor
authors.initials: I
authors.lastname: Lipchenca
authors.forename: Eyal
authors.initials: E
authors.lastname: Nof
authors.forename: Rafael
authors.initials: R
authors.lastname: Kuperstein
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Michael
authors.initials: M
authors.lastname: Eldar
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
authors.forename: Roy
authors.initials: R
authors.lastname: Beinart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: cardiac resynchronization therapy; functional response; heart failure; mortality outcome; renal dysfunction