title: Clinical decision tool for CRT-P vs. CRT-D implantation: Findings from PROSE-ICD.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) devices reduce mortality through pacing-induced cardiac resynchronization and implantable cardioverter defibrillator (ICD) therapy for ventricular arrhythmias (VAs). Whether certain factors can predict if patients will benefit more from implantation of CRT pacemakers (CRT-P) or CRT defibrillators (CRT-D) remains unclear.
  
  
  RESULTS
  We followed 305 primary prevention CRT-D recipients for the two primary outcomes of HF hospitalization and ICD therapy for VAs. Serum biomarkers, electrocardiographic and clinical variables were collected prior to implant. Multivariable analysis using Cox-proportional hazards model was used to fit the final models. Among 282 patients with follow-up outcome data, 75 (26.6%) were hospitalized for HF and 31 (11%) received appropriate ICD therapy. Independent predictors of HF hospitalization were atrial fibrillation (HR = 1.8 (1.1,2.9)), NYHA class III/IV (HR = 2.2 (1.3,3.6)), ejection fraction <20% (HR = 1.7 (1.1,2.7)), HS-IL6 >4.03pg/ml (HR = 1.7 (1.1,2.9)) and hemoglobin (<12g/dl) (HR = 2.2 (1.3,3.6)). Independent predictors of appropriate therapy included BUN >20mg/dL (HR = 3.0 (1.3,7.1)), HS-CRP >9.42mg/L (HR = 2.3 (1.1,4.7)), no beta blocker therapy (HR = 3.2 (1.4,7.1)) and hematocrit ≥38% (HR = 2.7 (1.03,7.0)). Patients with 0-1 risk factors for appropriate therapy (IR 1 per 100 person-years) and ≥3 risk factors for HF hospitalization (IR 23 per 100-person-years) were more likely to die prior to receiving an appropriate ICD therapy.
  
  
  CONCLUSIONS
  Clinical and biomarker data can risk stratify CRT patients for HF progression and VAs. These findings may help characterize subgroups of patients that may benefit more from the use of CRT-P vs. CRT-D systems.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00733590.
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America.
authors.forename: Victor
authors.initials: V
authors.lastname: Nauffal
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America.
authors.forename: Tanyanan
authors.initials: T
authors.lastname: Tanawuttiwat
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Elena
authors.initials: E
authors.lastname: Blasco-Colmenares
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America.
authors.forename: Barbara
authors.initials: B
authors.lastname: Butcher
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Norgard
authors.affiliation: Department of Medicine, University of Maryland, Baltimore, Maryland, United States of America.
authors.forename: Timm-Michael
authors.initials: TM
authors.lastname: Dickfeld
authors.affiliation: Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America.
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Tomaselli
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America.
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D020000:Decision Support Systems, Clinical; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged