ORIGINAL ARTICLES

Heart failure and cardiomyopathy

Difference in long-term clinical outcome after cardiac resynchronisation therapy between ischaemic and non-ischaemic aetiologies of heart failure

Q Zhang, J W-H Fung, J Y-S Chan, G Yip, Y-Y Lam, Y-J Liang, C-M Yu

Li Ka Shing Institute of Health Sciences and Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

Professor Cheuk-Man Yu, Li Ka Shing Institute of Health Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong; cmyu{at}cuhk.edu.hk

Objective: To examine the impact of heart failure (HF) aetiology on long-term outcome after cardiac resynchronisation therapy (CRT).

Design: Prospective cohort study.

Setting: University hospital.

Patients: 119 patients (44% with ischaemic and 56% non-ischaemic aetiology) who underwent CRT.

Interventions: Clinical follow-up for 39 (24) months.

Main outcome measures: Cardiovascular mortality, HF and cardiovascular hospitalisation were compared by Kaplan-Meier curves between the two groups, followed by Cox regression analysis for prognostic predictor(s).

Results: 41 (34%) patients died, in whom cardiovascular causes were identified in 32 (27%) patients. The ischaemic group had a higher cardiovascular mortality (log-rank ² = 4.293, p = 0.038) and cardiovascular hospitalisation (log-rank ² = 5.123, p = 0.024) when compared with the non-ischaemic group, though no difference was found in HF hospitalisation (log-rank ² = 0.019, p = 0.892). At three months, left ventricular reverse remodelling occurred in 52% of the ischaemic group and 55% of the non-ischaemic group (² = 0.128, p = 0.720). By Cox regression analysis, ischaemic aetiology and absence of reverse remodelling at three months were independent predictors of cardiovascular mortality (HR = 2.698, p = 0.032; HR = 3.541, p = 0.030) and cardiovascular hospitalisation (HR = 1.905, p = 0.015; HR = 2.361, p = 0.004). Furthermore, these two factors had an incremental value in predicting cardiovascular mortality when compared with either alone (left ventricular reverse remodelling, log-rank ² = 10.275 vs 6.311, p = 0.05; Ischaemic aetiology, log-rank ² = 10.275 vs 4.293, p<0.05).

Conclusion: Ischaemic aetiology of HF is an independent predictor of higher cardiovascular mortality and hospitalisation after CRT. This may implicate the progressive nature of coronary heart disease leading to a worse outcome despite similar short-term benefits of CRT.

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