European Heart Journal Advance Access originally published online on May 31, 2007
European Heart Journal 2007 28(15):1827-1834; doi:10.1093/eurheartj/ehm192
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Predictors and treatment response with cardiac resynchronization therapy in patients with heart failure characterized by dyssynchrony: a pre-defined analysis from the CARE-HF trial
1 Health Care Evaluation Group, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
2 Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, UK
3 Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy
Received 9 May 2006; revised 20 February 2007; accepted 13 April 2007; online publish-ahead-of-print 31 May 2007.
* Corresponding author. Tel: +44 121 414 7943; fax: +44 121 414 3353. E-mail address: n.freemantle{at}bham.ac.uk
See page 1790 for the editorial comment on this article (doi:10.1093/eurheartj/ehm254)
Aims: The cardiac resynchronization therapy in heart failure trial (CARE-HF) demonstrated that cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure and cardiac dyssynchrony. The aim of this study was to develop a prognostic model to evaluate the relationship between prospectively defined patient characteristics and treatment on the trial primary outcome of death from any cause or unplanned hospitalization for a major cardiovascular event.
Methods and results: A total of 813 patients were enrolled in the CARE-HF study and were followed for a mean of 29.4 months. A Cox Proportional Hazards Model was fitted to identify predictors of the primary outcome and any predictors that modified the effect of CRT. Ischaemic aetiology, more severe mitral regurgitation and increased N-terminal pro-brain natriuretic peptide, were associated with an increased risk of death or unplanned cardiovascular hospitalization irrespective of cardiac resynchronization [Hazard ratio (HR) 1.89, 95% CI 1.45–2.46, HR 1.71, 95% CI 1.38–2.12 and HR 1.31, 95% CI 1.17–1.47, respectively] and increasing systolic blood pressure with a decreasing risk of an event (HR 0.99, 95% CI 0.98–1.00). The benefits of cardiac resynchronization were modified by systolic blood pressure and interventricular mechanical delay (IVMD). Patients with increasing systolic blood pressure appear to receive reduced benefit from CRT (HR 1.02, 95% CI 1.00–1.03), whereas those patients with more severe IVMD appear to benefit more from treatment (HR 0.99, 95% CI 0.98–1.00).
Conclusion: Patients with echocardiographic evidence of more severe cardiac dyssynchrony and low systolic blood pressure obtain greater benefit from CRT, although benefits were substantial across the range of subjects included in the trial.
Key Words: Cardiac resynchronization therapy • Prognostic model
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