Predictors of long-term mortality with cardiac resynchronization therapy in mild heart failure patients with left bundle branch block

Yitschak Biton*, Jason Costa, Wojciech Zareba, Jayson R. Baman, Ilan Goldenberg, Scott McNitt, Scott D. Solomon, Bronislava Polonsky, Valentina Kutyifa

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Cardiac resynchronization therapy (CRT) is highly beneficial in patients with heart failure (HF) and left bundle branch block (LBBB); however, up to 30% of patients in this selected group are nonresponders. Hypothesis: We hypothesized that clinical and echocardiographic variables can be used to develop a simple mortality risk stratification score in CRT. Methods: Best-subsets proportional-hazards regression analysis was used to develop a simple clinical risk score for all-cause mortality in 756 patients with LBBB allocated to the CRT with defibrillator (CRT-D) group enrolled in the multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy. The score was used to assess the mortality risk within the CRT-D group and the associations with mortality reduction with CRT-D vs implantable cardioverter defibrillator (ICD) in each risk category. Results: Four clinical variables comprised the risk score: age ≥ 65, creatinine ≥ 1.4 mg/dL, history of coronary artery bypass graft, and left ventricular ejection fraction (LVEF) < 26%. Every 1 point increase in the score was associated with 2-fold increased mortality within the CRT-D arm (P < 0.001). CRT-D was associated with mortality reduction as compared with ICD only in patients with moderate risk: score 0 (HR = 0.80, P = 0.615), score 1 (HR = 0.54, P = 0.019), score 2 (HR = 0.54, P = 0.016), score 3-4 risk factors (HR = 1.08, P = 0.811); however, the device by score interaction was not significant (P = 0.306). The score was also significantly predictive of left ventricular reverse remodeling (P < 0.001). Conclusions: Four clinical variables can be used for improved mortality risk stratification in mild HF patients with LBBB implanted with CRT-D.

Original languageEnglish
Pages (from-to)1358-1366
Number of pages9
JournalClinical Cardiology
Volume41
Issue number10
DOIs
StatePublished - Oct 2018
Externally publishedYes

Funding

FundersFunder number
Boston Scientific Corporation

    Keywords

    • cardiac resynchronization therapy
    • heart failure
    • left bundle branch block
    • risk factors

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