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Abstract: Poster Presentations |

IMPACT OF CREATININE CLEARANCE IN PATIENTS WITH CARDIAC RESYNCHRONIZATION THERAPY EVALUATED BY MULTIVARIATE REGRESSION FREE TO VIEW

Suman Pasupuleti, MD*; Xuedong Shen, MD; Chandra K. Nair, MD; Claire Hunter, MD; Mark J. Holmberg, MD; Aryan N. Mooss, MD; Tom Hee, MD; Giri Andhukuri, MD; Stephanie Maciejewski, PharmD; Dennis Esterbrooks, MD
Author and Funding Information

The Cardiac Center of Creighton University, Omaha, NE


Chest


Chest. 2009;136(4_MeetingAbstracts):102S. doi:10.1378/chest.136.4_MeetingAbstracts.102S-b
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Abstract

PURPOSE:  Impact of Creatinine Clearance (CrCl) in patients with cardiac resynchronization therapy (CRT) has not been established. We hypothesized that CrCl could be used in predicting CRT response and mortality.

METHODS:  We studied 107 patients on CRT (male 78, age 69.7 ± 9.6 years). Patients with atrial fibrillation were excluded. There were 22 variables in the analysis including age, gender and CrCl. The CrCl was computed using the Cockroft-Gault Equation and corrected by body surface area. A decrease of left ventricular end systolic volume ≥ 15% after CRT was defined as a positive response to CRT.

RESULTS:  The mean CrCl at baseline was 50.7 ± 21.1 (16.7–104.4) ml/min. There was no significant difference in CrCl between baseline and after CRT (50.1 ± 23.7 ml/min, p = 0.85). There was no significant difference in CrCl between responders (51.6 ± 24.2 ml/min) and non-responders (50 ± 18.6 ml/ml, p = 0.69). The area under ROC curve (AUC) for CrCl predicting response to CRT was poor (AUC= 0.49, p = 0.88). CrCl was not related to CRT response by univariate regression (odds ratio= 1.004, p = 0.69). However, CrCl in patients who died (37.2 ± 15.3 ml/min) was significantly lower compared to those alive (50.7 ± 21.2 ml/min, p = 0.002) during follow-up of 17.4 ± 10.5 months. The area under ROC curve (AUC) of CrCl to predicting mortality was 0.72 (p = 0.0001). The cutoff point for CrCl to predict mortality was ≤;35.4 ml/min. Odds ratio (OR) of CrCl for predicting mortality was 5.35 (95% CI 1.88- 15.25, p = 0.002) by univariate regression. After adjustment for 7 variables with significant difference by univariate regression, CrCl ≤;35.4 ml/min was continuously related to mortality (odds ratio= 4.84, 95% CI= 1.44- 16.29, p = 0.01) (Fig). CrCl ≤;35.4 ml/min was associated with 4.84-fold increase in mortality compared to CrCl > 35.4 ml/min.

CONCLUSION:  CCrCl ≤; 35.4 ml/min predicts higher mortality after CRT. The ability of CrCl to predict CRT response was limited.

CLINICAL IMPLICATIONS:  Patients with CrCl ≤; 35.4 ml/min are not good candidates to receive CRT.

DISCLOSURE:  Suman Pasupuleti, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, November 4, 2009

12:45 PM - 2:00 PM


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