Differential outcome of cardiac resynchronization therapy in ischemic cardiomyopathy and idiopathic dilated cardiomyopathy

Christopher J. McLeod, Win Kuang Shen, Robert F. Rea, Paul Andrew Friedman, David L. Hayes, Anita Wokhlu, Tracy L. Webster, Heather J. Wiste, David O. Hodge, David John Bradley, Stephen C. Hammill, Douglas L Packer, Yong-Mei Cha

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: Cardiac resynchronization therapy (CRT) is a therapy of proven benefit in patients with advanced heart failure. Identifying potential responders remains challenging, and whether the etiology of the heart failure is related to the potential hemodynamic benefit and long-term outcome of CRT is unclear. Objective: The purpose of this study was to evaluate whether heart failure etiology (ischemic cardiomyopathy [ICM] vs nonischemic dilated cardiomyopathy [DCM]) was associated with CRT outcome and implantable cardioverter-defibrillator (ICD) shocks. Methods: The study included 503 CRT recipients (CRT-D 90%) in a longitudinal CRT database: ICM (n = 312) and DCM (n = 191). Clinical variables and echocardiographic measures preimplant and postimplant were collected. Actuarial survival and ICD therapy data were assessed with Kaplan-Meier curve and log rank tests. Results: Pre-CRT, ICM patients were older and had higher creatinine levels (P <.001). At median follow-up of 7.1 months, the DCM group experienced greater improvement in left ventricular ejection fraction (8.3% ± 10% vs 6.2% ± 10%, P = .05) and left ventricular end-diastolic volumes than did those with ICM (-28%.4 ± 53 mL vs -15.3 ± 46 mL, P = .024). Survival estimates at 4 years were 55% for ICM and 77% for DCM groups (P <.001), respectively, whereas no significant difference in the incidence of appropriate/inappropriate ICD shocks was observed. The ICM group remained at higher risk for death compared to the DCM group after controlling for preimplant variables (hazard ratio 1.6, 95% confidence interval 1.12.3, P = .008). Conclusion: In response to CRT and in contrast to ICM, DCM patients experienced greater improvement in left ventricular systolic function and reverse remodeling while also sustaining a greater survival benefit.

Original languageEnglish (US)
Pages (from-to)377-382
Number of pages6
JournalHeart Rhythm
Volume8
Issue number3
DOIs
StatePublished - Mar 2011

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Cardiac Resynchronization Therapy
Dilated Cardiomyopathy
Cardiomyopathies
Implantable Defibrillators
Heart Failure
Stroke Volume
Survival
Shock
Left Ventricular Function
Creatinine
Hemodynamics
Databases
Confidence Intervals
Incidence
Therapeutics

Keywords

  • Cardiac resynchronization therapy
  • Cardiomyopathy
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Differential outcome of cardiac resynchronization therapy in ischemic cardiomyopathy and idiopathic dilated cardiomyopathy. / McLeod, Christopher J.; Shen, Win Kuang; Rea, Robert F.; Friedman, Paul Andrew; Hayes, David L.; Wokhlu, Anita; Webster, Tracy L.; Wiste, Heather J.; Hodge, David O.; Bradley, David John; Hammill, Stephen C.; Packer, Douglas L; Cha, Yong-Mei.

In: Heart Rhythm, Vol. 8, No. 3, 03.2011, p. 377-382.

Research output: Contribution to journalArticle

McLeod, Christopher J. ; Shen, Win Kuang ; Rea, Robert F. ; Friedman, Paul Andrew ; Hayes, David L. ; Wokhlu, Anita ; Webster, Tracy L. ; Wiste, Heather J. ; Hodge, David O. ; Bradley, David John ; Hammill, Stephen C. ; Packer, Douglas L ; Cha, Yong-Mei. / Differential outcome of cardiac resynchronization therapy in ischemic cardiomyopathy and idiopathic dilated cardiomyopathy. In: Heart Rhythm. 2011 ; Vol. 8, No. 3. pp. 377-382.
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abstract = "Background: Cardiac resynchronization therapy (CRT) is a therapy of proven benefit in patients with advanced heart failure. Identifying potential responders remains challenging, and whether the etiology of the heart failure is related to the potential hemodynamic benefit and long-term outcome of CRT is unclear. Objective: The purpose of this study was to evaluate whether heart failure etiology (ischemic cardiomyopathy [ICM] vs nonischemic dilated cardiomyopathy [DCM]) was associated with CRT outcome and implantable cardioverter-defibrillator (ICD) shocks. Methods: The study included 503 CRT recipients (CRT-D 90{\%}) in a longitudinal CRT database: ICM (n = 312) and DCM (n = 191). Clinical variables and echocardiographic measures preimplant and postimplant were collected. Actuarial survival and ICD therapy data were assessed with Kaplan-Meier curve and log rank tests. Results: Pre-CRT, ICM patients were older and had higher creatinine levels (P <.001). At median follow-up of 7.1 months, the DCM group experienced greater improvement in left ventricular ejection fraction (8.3{\%} ± 10{\%} vs 6.2{\%} ± 10{\%}, P = .05) and left ventricular end-diastolic volumes than did those with ICM (-28{\%}.4 ± 53 mL vs -15.3 ± 46 mL, P = .024). Survival estimates at 4 years were 55{\%} for ICM and 77{\%} for DCM groups (P <.001), respectively, whereas no significant difference in the incidence of appropriate/inappropriate ICD shocks was observed. The ICM group remained at higher risk for death compared to the DCM group after controlling for preimplant variables (hazard ratio 1.6, 95{\%} confidence interval 1.12.3, P = .008). Conclusion: In response to CRT and in contrast to ICM, DCM patients experienced greater improvement in left ventricular systolic function and reverse remodeling while also sustaining a greater survival benefit.",
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AU - Webster, Tracy L.

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