Predicting the Long-Term Effects of Cardiac Resynchronization Therapy on Mortality From Baseline Variables and the Early ResponseA Report From the CARE-HF (Cardiac Resynchronization in Heart Failure) Trial
John Cleland, MD, FRCP, FACC*,*,
Nick Freemantle, PhD ,
Stefano Ghio, MD ,
Friedrich Fruhwald, MD ,
Aparna Shankar, PhD,
Monique Marijanowski, PhD||,
Yves Verboven|| and
Luigi Tavazzi, MD, FESC
* Department of Cardiology, University of Hull, Hull, United Kingdom
Department of Primary Care and General Practice, University of Birmingham, Birmingham, United Kingdom
Department of Cardiology, Policlinico S Matteo, Pavia, Italy
Department of Internal Medicine, Medical University of Graz, Graz, Austria
|| Medtronic Bakken Research Center B.V., Maastricht, the Netherlands.
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Figure 1 Outcome in Patients With and Without Ischemic Heart Disease as the Reported Cause of LVSD
Hazard ratio for patients with ischemic heart disease compared with those without ischemic heart disease was 1.546 (95% confidence interval 1.129 to 2.118; p = 0.0066). LVSD = left ventricular systolic dysfunction.
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Figure 2 Outcome in Patients According to Baseline Duration of IVMD
Values for interventricular mechanical delay (IVMD) of 38 and 61 ms defined the upper and lower boundaries of the middle tercile. The hazard ratio for those in the highest versus lowest tercile was 0.473 (95% confidence interval: 0.340 to 0.657; p < 0.0001). Tr = tercile.
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Figure 3 Outcome in Patients According to Baseline NYHA Functional Class
Hazard ratio for those in New York Heart Association (NYHA) functional class IV versus III was 2.228 (95% confidence interval: 1.341 to 3.701; p = 0.0020).
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Figure 4 Outcome in Patients According to Plasma Concentration of NT-proBNP Achieved by 3 Months
Plasma concentrations of amino terminal pro–brain natriuretic peptide (NT-proBNP) of 812 (log: 6.7) and 2,622 (log: 7.8) pg/ml defined the upper and lower boundaries of the middle tercile. The hazard ratio for those in the highest versus lowest tercile was 5.682 (95% confidence interval: 3.819 to 8.455; p < 0.0001). Tr = tercile. BNP = brain natriuretic peptide.
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Figure 5 Outcome in Patients According to Severity of MR Index at 3 Months
Values for mitral regurgitation (MR) index of 11.1 and 24.2 units defined the upper and lower boundaries of the middle tercile. The hazard ratio for those in the highest versus lowest tercile was 2.673 (95% confidence interval: 1.881 to 3.799; p < 0.0001). Tr = tercile.
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Figure 6 Mortality According to Assigned Therapy, Adjusting for Baseline Variables and Initial Response
The adjusted hazard ratio for those assigned to cardiac resynchronization therapy (CRT) was 0.672 (95% confidence interval: 0.494 to 0.914; p = 0.0113). The unadjusted hazard ratio was 0.60 (95% confidence interval: 0.47 to 0.77; p <0.0001). The curves do not differ appreciably from those derived from unadjusted data and published previously in Cleland et al. (2,3).
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