Prognostication of poor survival after cardiac resynchronization therapy

Abstract

Background and Objectives: Cardiac resynchronization therapy (CRT) is a successful treatment option for appropriately selected patients. However, one–third of recipients do not experience any positive outcome or their condition even declines. We aimed to assess preimplantation factors associated with worse survival after the CRT. Materials and Methods: This was a retrospective unicenter trial. The study cohort included 183 consecutive CRT-treated patients. Baseline demographic, clinical, electrocardiographic, and echocardiographic characteristics were analyzed. Results: After the median follow-up of 15.6 months (9.3–26.3), 20 patients had died (11%). In multivariate Cox regression analysis, ischemic origin of heart failure (HF) was a significant predictor of poor survival (adjusted hazard ratio (aHR) 15.235, 95% confidence interval (CI) (1.999–116.1), p = 0.009). In univariate Cox regression, tricuspid annular plane systolic excursion (TAPSE) <15.5 mm (sensitivity 0.824, specificity 0.526; HR 5.019, 95% CI (1.436–17.539), p = 0.012), post-implantation prescribed antiplatelet agents (HR 2.569, 95% CI (1.060–6.226), p = 0.037), statins (HR 2.983, 95% CI (1.146–7.764), p = 0.025), and nitrates (HR 3.694, 95% CI (1.342–10.171), p = 0.011) appeared to be related with adverse outcome. Conclusions: ischemic etiology of HF is a significant factor associated with worse survival after the CRT. Decreased TAPSE is also related to poor survival.