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.
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.
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.
CCrCl ≤; 35.4 ml/min predicts higher mortality after CRT. The ability of CrCl to predict CRT response was limited.
Patients with CrCl ≤; 35.4 ml/min are not good candidates to receive CRT.
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