open access

Vol 23, No 3 (2016)
ARRHYTMOLOGY Original articles
Published online: 2016-04-07
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Metabolic syndrome is associated with different clinical outcome after cardiac resynchronization therapy in patients with ischemic and non-ischemic cardiomyopathy

Barbara Szepietowska, Scott McNitt, Bronislava Polonsky, Saadia Sherazi, Yitschak Biton, Valentina Kutyifa, Mehmet K. Aktas, Arthur J. Moss, Wojciech Zareba
DOI: 10.5603/CJ.a2016.0017
·
Pubmed: 27064797
·
Cardiol J 2016;23(3):344-351.

open access

Vol 23, No 3 (2016)
ARRHYTMOLOGY Original articles
Published online: 2016-04-07

Abstract

Background: Although association of metabolic syndrome (MS) and ischemic heart disease is strongly established, it is not known whether presence of MS may differently influence clinical responses to cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the associations between obesity and metabolic features and the clinical outcome after cardiac resynchronization with defibrillator therapy (CRT-D), compared to an implantable cardioverter defibrillator (ICD).

Methods: The risk of heart failure (HF) or death and death alone was evaluated in 829 non-obese patients, 156 obese patients without MS, and 277 obese patients with MS (all with left bundle branch block), who were enrolled in the Multicenter Automatic Defibrillator Implanta­tion Trial with Cardiac Resynchronization Therapy (MADIT-CRT).

Results: Obese patients with MS (HR 0.50, 95% CI 0.32–0.77, p = 0.002), obese patients without MS (HR 0.57, 95% CI 0.30–1.06, p = 0.077), and non-obese patients (HR 0.48, 95% CI 0.37–0.62, p < 0.001) had a similar risk reduction of HF/death in response to CRT-D therapy when compared to ICD patients. However, among those with non-ischemic cardiomyo­pathy, obese patients with MS experienced a 90% reduction for HF/death (HR 0.11, 95% CI 0.04–0.32, p < 0.001), whereas obese patients without MS had no reduction (HR 0.98, 95% CI 0.48–1.98, p = 0.951; interaction p < 0.001). The reverse was observed in ischemic car­diomyopathy patients: obese patients with MS had no reduction in the risk of HF/death (HR 0.80, 95% CI 0.48–1.34, p = 0.402), while obese patients without MS showed a significant reduction in the risk of events (HR 0.15, 95% CI 0.04–0.65, p = 0.011; interaction p = 0.036). Similar trends were observed for the endpoint of death.

Conclusions: Presence of MS differentiates the response to CRT in obese patients with is­chemic and non-ischemic etiology for HF.

Abstract

Background: Although association of metabolic syndrome (MS) and ischemic heart disease is strongly established, it is not known whether presence of MS may differently influence clinical responses to cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the associations between obesity and metabolic features and the clinical outcome after cardiac resynchronization with defibrillator therapy (CRT-D), compared to an implantable cardioverter defibrillator (ICD).

Methods: The risk of heart failure (HF) or death and death alone was evaluated in 829 non-obese patients, 156 obese patients without MS, and 277 obese patients with MS (all with left bundle branch block), who were enrolled in the Multicenter Automatic Defibrillator Implanta­tion Trial with Cardiac Resynchronization Therapy (MADIT-CRT).

Results: Obese patients with MS (HR 0.50, 95% CI 0.32–0.77, p = 0.002), obese patients without MS (HR 0.57, 95% CI 0.30–1.06, p = 0.077), and non-obese patients (HR 0.48, 95% CI 0.37–0.62, p < 0.001) had a similar risk reduction of HF/death in response to CRT-D therapy when compared to ICD patients. However, among those with non-ischemic cardiomyo­pathy, obese patients with MS experienced a 90% reduction for HF/death (HR 0.11, 95% CI 0.04–0.32, p < 0.001), whereas obese patients without MS had no reduction (HR 0.98, 95% CI 0.48–1.98, p = 0.951; interaction p < 0.001). The reverse was observed in ischemic car­diomyopathy patients: obese patients with MS had no reduction in the risk of HF/death (HR 0.80, 95% CI 0.48–1.34, p = 0.402), while obese patients without MS showed a significant reduction in the risk of events (HR 0.15, 95% CI 0.04–0.65, p = 0.011; interaction p = 0.036). Similar trends were observed for the endpoint of death.

Conclusions: Presence of MS differentiates the response to CRT in obese patients with is­chemic and non-ischemic etiology for HF.

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Keywords

obesity, metabolic syndrome, cardiac resynchronization therapy, implantable cardioverter defibrillator, heart failure, clinical outcome

About this article
Title

Metabolic syndrome is associated with different clinical outcome after cardiac resynchronization therapy in patients with ischemic and non-ischemic cardiomyopathy

Journal

Cardiology Journal

Issue

Vol 23, No 3 (2016)

Pages

344-351

Published online

2016-04-07

DOI

10.5603/CJ.a2016.0017

Pubmed

27064797

Bibliographic record

Cardiol J 2016;23(3):344-351.

Keywords

obesity
metabolic syndrome
cardiac resynchronization therapy
implantable cardioverter defibrillator
heart failure
clinical outcome

Authors

Barbara Szepietowska
Scott McNitt
Bronislava Polonsky
Saadia Sherazi
Yitschak Biton
Valentina Kutyifa
Mehmet K. Aktas
Arthur J. Moss
Wojciech Zareba

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