Effects of Upgrade Versus De Novo Cardiac Resynchronization Therapy on Clinical Response and Long-Term Survival: Results from a Multicenter Study

Mate Vamos; Julia W Erath; Zsolt Bari; Denes Vagany; Sven P Linzbach; Tatsiana Burmistrava; Carsten W Israel; Gabor Z Duray; Stefan H Hohnloser

doi:10.1161/CIRCEP.116.004471

Effects of Upgrade Versus De Novo Cardiac Resynchronization Therapy on Clinical Response and Long-Term Survival: Results from a Multicenter Study

Circ Arrhythm Electrophysiol. 2017 Feb;10(2):e004471. doi: 10.1161/CIRCEP.116.004471.

Authors

Mate Vamos¹, Julia W Erath¹, Zsolt Bari¹, Denes Vagany¹, Sven P Linzbach¹, Tatsiana Burmistrava¹, Carsten W Israel¹, Gabor Z Duray¹, Stefan H Hohnloser²

Affiliations

¹ From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.).
² From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.). hohnloser@em.uni-frankfurt.de.

PMID: 28202628
DOI: 10.1161/CIRCEP.116.004471

Abstract

Background: Benefits of cardiac resynchronization therapy (CRT) on morbidity and mortality in selected patients are well known. Although the number of upgrade procedures from single- or dual-chamber devices to CRT is increasing, there are only sparse data on the outcomes of upgrade procedures compared with de novo CRT. This study aimed to evaluate clinical response and survival in patients receiving de novo versus upgrade CRT defibrillator therapy.

Methods and results: Prospectively collected outcome data were compared in patients undergoing de novo or upgrade CRT defibrillator implantation at 3 implant centers in Germany and Hungary. Clinical response was defined as an improvement by at least one New York Heart Association (NYHA) functional class. CRT implantation was performed in 552 consecutive patients of whom 375 underwent a de novo and 177 an upgrade procedure. Upgrade patients were more often implanted for secondary prevention, suffered more often from atrial fibrillation, chronic kidney disease, diabetes mellitus, and dyslipidemia, and had more often a non-LBBB (left bundle branch block) wide QRS complex, and lower left ventricular ejection fraction. Upgrade procedures were associated with a lower response rate compared to the de novo group (57% versus 69%, P univariate=0.008, P multivariate=0.021). During the follow-up of 37±28 months, survival was worse after upgrade compared with de novo CRT defibrillator implantations (hazard ratio, 1.65; 95% confidence interval, 1.22-2.24; P=0.001) even after careful adjustment for important baseline variables (adjusted hazard ratio, 1.68; 95% confidence interval, 1.20-2.34; P=0.002) and after propensity-score matching (propensity-adjusted hazard ratio, 1.79; 95% confidence interval, 1.08-2.95; P=0.023).

Conclusions: Both clinical response and long-term survival were less favorable in patients undergoing CRT upgrade compared to de novo implantations.

Keywords: cardiac resynchronization therapy; heart failure; hypertension; morbidity; mortality.

Publication types

Multicenter Study

MeSH terms

Aged
Cardiac Resynchronization Therapy / methods*
Echocardiography
Female
Germany
Heart Failure / diagnostic imaging
Heart Failure / mortality
Heart Failure / therapy*
Humans
Hungary
Male
Patient Selection
Propensity Score
Prospective Studies
Retreatment
Risk Factors
Secondary Prevention*
Survival Rate
Time Factors
Treatment Outcome