TY - JOUR
T1 - Cardiac Resynchronization Therapy Improves Renal Function in Human Heart Failure With Reduced Glomerular Filtration Rate
AU - Boerrigter, Guido
AU - Costello-Boerrigter, Lisa C.
AU - Abraham, William T.
AU - St. John Sutton, Martin G.
AU - Heublein, Denise M.
AU - Kruger, Kristin M.
AU - Hill, Michael R.S.
AU - McCullough, Peter A.
AU - Burnett, John C.
N1 - Funding Information:
Supported by grants from the NIH (POI HL076611 and HL36634 (J.C.B., Jr) HL07111 (G.B. and L.C.C.-B.)), and the Mayo Foundation. The MIRACLE trial was supported by Medtronic.
PY - 2008/9
Y1 - 2008/9
N2 - Background: Renal dysfunction is an important independent prognostic factor in heart failure (HF). Cardiac resynchronization therapy (CRT) improves functional status and left ventricular (LV) function in HF patients with ventricular dyssynchrony, but the impact of CRT on renal function is less defined. We hypothesized that CRT would improve glomerular filtration rate as estimated by the abbreviated Modification of Diet in Renal Disease equation (eGFR). Methods and Results: The Multicenter InSync Randomized Clinical Evaluation (MIRACLE) study evaluated CRT in HF patients with NYHA Class III-IV, ejection fraction ≤35%, and QRS ≥130 ms. Patients were evaluated before and 6 months after randomization to control (n = 225) or CRT (n = 228). Patients were categorized according to their baseline eGFR: ≥90 (category A), 60 ≤eGFR <90 (category B), and 30 ≤eGFR <60 (category C) mL/min per 1.73 m2. CRT improved LV function in all categories. Compared with control, CRT increased eGFR (-2.4 ± 1.2 vs. +2.7 ± 1.2 mL/min per 1.73 m2; P = .003) and reduced blood urea nitrogen (+6.4 ± 2.4 vs. -1.1 ± 1.5 mg/mL; P = .008) in category C, whereas no differences were observed in categories A and B. Conclusions: CRT increased eGFR and reduced blood urea nitrogen in HF patients with moderately reduced baseline eGFR. By improving cardiac function, CRT can indirectly improve renal function, underscoring the importance of cardiorenal interaction and providing another mechanism for the beneficial effects of CRT.
AB - Background: Renal dysfunction is an important independent prognostic factor in heart failure (HF). Cardiac resynchronization therapy (CRT) improves functional status and left ventricular (LV) function in HF patients with ventricular dyssynchrony, but the impact of CRT on renal function is less defined. We hypothesized that CRT would improve glomerular filtration rate as estimated by the abbreviated Modification of Diet in Renal Disease equation (eGFR). Methods and Results: The Multicenter InSync Randomized Clinical Evaluation (MIRACLE) study evaluated CRT in HF patients with NYHA Class III-IV, ejection fraction ≤35%, and QRS ≥130 ms. Patients were evaluated before and 6 months after randomization to control (n = 225) or CRT (n = 228). Patients were categorized according to their baseline eGFR: ≥90 (category A), 60 ≤eGFR <90 (category B), and 30 ≤eGFR <60 (category C) mL/min per 1.73 m2. CRT improved LV function in all categories. Compared with control, CRT increased eGFR (-2.4 ± 1.2 vs. +2.7 ± 1.2 mL/min per 1.73 m2; P = .003) and reduced blood urea nitrogen (+6.4 ± 2.4 vs. -1.1 ± 1.5 mg/mL; P = .008) in category C, whereas no differences were observed in categories A and B. Conclusions: CRT increased eGFR and reduced blood urea nitrogen in HF patients with moderately reduced baseline eGFR. By improving cardiac function, CRT can indirectly improve renal function, underscoring the importance of cardiorenal interaction and providing another mechanism for the beneficial effects of CRT.
KW - Heart failure
KW - cardiac resynchronization therapy
KW - glomerular filtration rate
KW - natriuretic peptides
KW - neurohormones
KW - renal dysfunction
UR - http://www.scopus.com/inward/record.url?scp=49549111147&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=49549111147&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2008.03.009
DO - 10.1016/j.cardfail.2008.03.009
M3 - Article
C2 - 18722318
AN - SCOPUS:49549111147
SN - 1071-9164
VL - 14
SP - 539
EP - 546
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 7
ER -