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Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up.

Publication ,  Journal Article
Zeitler, EP; Friedman, DJ; Daubert, JP; Al-Khatib, SM; Solomon, SD; Biton, Y; McNitt, S; Zareba, W; Moss, AJ; Kutyifa, V
Published in: J Am Coll Cardiol
May 16, 2017

BACKGROUND: Data regarding cardiac resynchronization therapy (CRT) in patients with multiple comorbidities are limited. OBJECTIVES: This study evaluated the association of multiple comorbidities with the benefits of CRT over implantable cardioverter-defibrillator (ICD) alone. METHODS: We examined 1,214 MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) study patients with left bundle branch block (LBBB) and 0, 1, 2, or ≥3 comorbidities, including renal dysfunction, hypertension (HTN), diabetes, coronary artery disease, history of atrial arrhythmias, history of ventricular arrhythmias, current smoking, and cerebrovascular accident. In an adjusted analysis, we analyzed risk of heart failure (HF) events or death by comorbidity group in all patients and in patients with CRT with defibrillator (CRT-D) versus ICD. Then we examined percent change in left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV ejection fraction, left atrial volume, and LV dyssynchrony at 1-year in CRT-D patients by comorbidity group. RESULTS: There was an inverse relationship between comorbidity burden and improvements in LV end-systolic volume, LV end-diastolic volume, left ventricular ejection fraction, left atrial volume, and LV dyssynchrony. In an adjusted model, there was an increasing risk of death or nonfatal HF events with increasing comorbidity burden regardless of treatment group (p < 0.001). During a mean follow-up of 4.65 years, there was no interaction with respect to comorbidity burden and the benefit of CRT-D versus ICD only for death or nonfatal HF events (interaction p = 0.943). In the groups with greatest comorbidity burden (2 and ≥3), the absolute risk reduction associated with CRT-D over ICD alone appeared greater than that seen for groups with less comorbidity burden (0 and 1). CONCLUSIONS: During long-term follow-up of MADIT-CRT study patients with LBBB randomized to CRT-D, there were differences in HF or death risk and in the degree of reverse remodeling among comorbidity groups. However, the burden of comorbidity does not appear to compromise the clinical benefits of CRT-D compared with ICD alone.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 16, 2017

Volume

69

Issue

19

Start / End Page

2369 / 2379

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Female
  • Echocardiography
  • Defibrillators, Implantable
  • Comorbidity
 

Citation

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Zeitler, E. P., Friedman, D. J., Daubert, J. P., Al-Khatib, S. M., Solomon, S. D., Biton, Y., … Kutyifa, V. (2017). Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up. J Am Coll Cardiol, 69(19), 2369–2379. https://doi.org/10.1016/j.jacc.2017.03.531
Zeitler, Emily P., Daniel J. Friedman, James P. Daubert, Sana M. Al-Khatib, Scott D. Solomon, Yitschak Biton, Scott McNitt, Wojciech Zareba, Arthur J. Moss, and Valentina Kutyifa. “Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up.J Am Coll Cardiol 69, no. 19 (May 16, 2017): 2369–79. https://doi.org/10.1016/j.jacc.2017.03.531.
Zeitler EP, Friedman DJ, Daubert JP, Al-Khatib SM, Solomon SD, Biton Y, et al. Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up. J Am Coll Cardiol. 2017 May 16;69(19):2369–79.
Zeitler, Emily P., et al. “Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up.J Am Coll Cardiol, vol. 69, no. 19, May 2017, pp. 2369–79. Pubmed, doi:10.1016/j.jacc.2017.03.531.
Zeitler EP, Friedman DJ, Daubert JP, Al-Khatib SM, Solomon SD, Biton Y, McNitt S, Zareba W, Moss AJ, Kutyifa V. Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up. J Am Coll Cardiol. 2017 May 16;69(19):2369–2379.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 16, 2017

Volume

69

Issue

19

Start / End Page

2369 / 2379

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Female
  • Echocardiography
  • Defibrillators, Implantable
  • Comorbidity