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Difference in Long-term Clinical Outcome after Cardiac Resynchronization Therapy Between Ischemic and Non-Ischemic Etiologies of Heart Failure
  1. Qing Zhang (qingzhang{at}cuhk.edu.hk)
  1. The Chinese University of Hong Kong, Hong Kong
    1. Jeffrey Wing-Hong Fung
    1. The Chinese University of Hong Kong, Hong Kong
      1. Joseph Yat-Sun Chan
      1. The Chinese University of Hong Kong, Hong Kong
        1. Gabriel Wai Kwok Yip
        1. The Chinese University of Hong Kong, Hong Kong
          1. Yat Yin Lam
          1. The Chinese University of Hong Kong, Hong Kong
            1. Yu Jia Liang
            1. The Chinese University of Hong Kong, Hong Kong
              1. Cheuk-Man Yu (cmyu{at}cuhk.edu.hk)
              1. The Chinese University of Hong Kong, Hong Kong

                Abstract

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

                Design: Prospective cohort study.

                Setting: University hospital.

                Patients: One hundred and nineteen patients (44% with ischemic and 56% non-ischemic etiology) who underwent CRT.

                Interventions: Clinical follow up for 39¡À24 months.

                Main outcome measures: Cardiovascular mortality, HF and cardiovascular hospitalization were compared by Kaplan-Meier curves between the 2 groups, followed by Cox regression analysis for prognostic predictor(s).

                Results: Forty-one (34%) patients died, in whom cardiovascular causes were identified in 32 (27%) patients. The ischemic group had a higher cardiovascular mortality (Log-rank ??χ2=4.293, p=0.038) and cardiovascular hospitalization (Log-rank ??χ2=5.123, p=0.024) when compared with the non-ischemic group, though no difference was found in HF hospitalization (Log-rank ??χ2=0.019, p=0.892). At 3-month, left ventricular reverse remodeling occurred in 52% of the ischemic group and 55% of the non-ischemic group (??χ2 =0.128, p=0.720). By Cox regression analysis, ischemic etiology and absence of reverse remodeling at 3-month were independent predictors of cardiovascular mortality (HR=2.698, p=0.032; HR=3.541, p=0.030) and cardiovascular hospitalization (HR=1.905, p=0.015; HR=2.361, p=0.004). Furthermore, these 2 factors had an incremental value in predicting cardiovascular mortality when compared with either alone (LV reverse remodeling, Log-rank ??χ2=10.275 vs. 6.311, p=0.05; Ischemic etiology, Log-rank ??χ2=10.275 vs. 4.293, p<0.05).

                Conclusion: Ischemic etiology of HF is an independent predictor of higher cardiovascular mortality and hospitalization 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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