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Eur Heart J. 2015 Nov 1;36(41):2767-76. doi: 10.1093/eurheartj/ehv455. Epub 2015 Sep 1.

Causes-of-death analysis of patients with cardiac resynchronization therapy: an analysis of the CeRtiTuDe cohort study.

Collaborators (190)

Le Heuzey JY, Cauchemez B, Khemache A, Thomas O, Hermida JS, Kubala M, Mathiron A, Traullé S, Dupuis JM, Foucault A, Tassin A, Algalarrondo V, Dinanian S, Juin C, Sebag C, Briand F, Guignier A, Janin S, Champ-Rigot L, Gomes S, Milliez P, Pellissier A, Scanu P, Barthez O, Bertaux-Cattarossi G, Duvernay-Debin R, Farnier F, Laurent G, Martel-Bourcier A, Defaye P, Jacon P, Durand C, Durand-Dubief A, Monsarrat N, Poty H, Boulé S, Brigadeau F, Fossati F, Guédon-Moreau L, Jarwe M, Kacet S, Klug D, Kouakam C, Lacroix D, Marquie C, Blanc P, Echahidi N, Espaliat E, Guy-Moyat B, Lesage J, Deharo JC, Franceschi F, Prévot S, Aliot E, Andronache M, Brembillat Perrot B, de Chillou C, Sadoul N, Badenco N, Chastre T, Duthoit G, Frank R, Gandjbakhch E, Gartenlaub O, Hidden-Lucet F, Himbert C, Waintraub X, Zerah T, Bauley K, Chabert JP, Deschildre A, Lesaffre F, Martin A, Rio C, Daubert JC, Leclercq C, Mabo P, Pavin D, Anselme F, Godin B, Savouré A, Bisch L, Da Costa A, Romeyer C, Bakou Boula B, Bronner F, Chauvin M, Douchet MP, Jesel L, Marzak H, Schatz A, Cardin C, Chilon T, Delay M, Duparc A, Garderes-Rollin A, Maury P, Mondoly P, Somody E, Thomson E, Chevalier P, Dulac A, Mlotek M, Nonin-Babary E, Jouven X, Lavergne T, Le Heuzey JY, Marijon E, Otmani A, Burban M, Cebron JP, Gras D, Barraud P, Langlade S, Lipiecki J, Philippot F, Richard A, Robin I, Schandrin C, Vacher D, Cardin C, Reza Rezaei M, Rumeau P, Fouché R, Fromentin S, Khattar P, Le Potier J, Mouhid J, Palud L, Andres H, Boureux C, Chopat P, Nadji G, Sultan P, Targosz F, Doazan JP, El Hajjaji N, Hannachi S, Noblemaire R, Somody E, Copie X, Lascault G, Paziaud O, Piot O, Billon O, Gully C, Haddad G, Lipp D, Mouhoub D, Bru P, Duplantier-Duchêne C, Milhem A, Bertrand J, Boursier M, Khalife K, Zannad N, Zanutto A, Cuvelier E, Donfafk C, Graux P, Guiot A, Guyomar Y, Heuls S, Kallumannil J, Semichon M, Gal B, Lopez M, Pineau J, Dreyfus X, Hammer L, Petit L, Harle X, Laborderie J, Albenque JP, Boveda S, Combes N, Combes S, Goutner C, Césari O, Chenevez P, Loose C, Peycher P, Durand C, Durand-Dubief A, Poty H, Alonso C, Cazeau S, Grimard C, Jauvert G, Lazarus A.

Author information

1
Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France Paris Cardiovascular Research Centre, Paris, France.
2
Pontchaillou University Hospital and INSERM 1099, CIC-IT 804 Rennes, France.
3
Paris Cardiovascular Research Centre, Paris, France.
4
Clinique Pasteur, Toulouse, France.
5
Lille University Hospital and University of Lille, Lille, France.
6
Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France.
7
Arrhythmia Department, University Hospital, Grenoble, France.
8
Epidemiology Unit, IRSN, Paris, France.
9
Centre Cardiologique du Nord, Saint Denis, France.
10
Cardiology Division, Hôpital La Timone, Marseille, France.
11
French Society of Cardiology, Paris, France.
12
Amiens University Hospital, Amiens, France.
13
Caen University Hospital, Caen, France.
14
Nouvelles Cliniques Nantaises, Nantes, France.
15
Clinique Saint Gatien, Tours, France.
16
Cardiology Department, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
17
Cardiology Division, Rouen University Hospital, Rouen, France.
18
East Lyon School of Medicine, Louis Pradel Hospital, Bron, France.
19
Cardiology Division, Rangueil University Hospital, Toulouse, France.
20
Cardiology Division, Nancy University Hospital, Nancy, France.
21
Haut-Lévêque Hospital, Bordeaux, France.
22
Saint Joseph Hospital, Paris, France.
23
Strasbourg University Hospital, Strasbourg, France.
24
Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France Paris Cardiovascular Research Centre, Paris, France jean-yves.le-heuzey@egp.aphp.fr.

Abstract

AIMS:

The choice of resynchronization therapy between with (CRT-D) and without (CRT-P) a defibrillator remains a contentious issue. Cause-of-death analysis among CRT-P, compared with CRT-D, patients could help evaluate the extent to which CRT-P patients would have additionally benefited from a defibrillator in a daily clinical practice.

METHODS AND RESULTS:

A total of 1705 consecutive patients implanted with a CRT (CRT-P: 535 and CRT-D: 1170) between 2008 and 2010 were enrolled in CeRtiTuDe, a multicentric prospective follow-up cohort study, with specific adjudication for causes of death at 2 years. Patients with CRT-P compared with CRT-D were older (P < 0.0001), less often male (P < 0.0001), more symptomatic (P = 0.0005), with less coronary artery disease (P = 0.003), wider QRS (P = 0.002), more atrial fibrillation (P < 0.0001), and more co-morbidities (P = 0.04). At 2-year follow-up, the annual overall mortality rate was 83.80 [95% confidence interval (CI) 73.41-94.19] per 1000 person-years. The crude mortality rate among CRT-P patients was double compared with CRT-D (relative risk 2.01, 95% CI 1.56-2.58). In a Cox proportional hazards regression analysis, CRT-P remained associated with increased mortality (hazard ratio 1.54, 95% CI 1.07-2.21, P = 0.0209), although other potential confounders may persist. By cause-of-death analysis, 95% of the excess mortality among CRT-P subjects was related to an increase in non-sudden death.

CONCLUSION:

When compared with CRT-D patients, excess mortality in CRT-P recipients was mainly due to non-sudden death. Our findings suggest that CRT-P patients, as currently selected in routine clinical practice, would not potentially benefit with the addition of a defibrillator.

KEYWORDS:

Cardiac resynchronization; Cardioverter defibrillator; Competing risk; Heart failure; Sudden death

PMID:
26330420
PMCID:
PMC4628644
DOI:
10.1093/eurheartj/ehv455
[Indexed for MEDLINE]
Free PMC Article

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