Structural adult congenital heart disease patients undergoing CRT had similar adjusted mortality to ischemic or nonischemic cardiomyopathy, despite lower unadjusted rates (21.7% vs 41.5% and 33.6%).
Observational (n=1,014)
No
Does cardiac resynchronization therapy result in similar long-term outcomes in patients with structural adult congenital heart disease compared to those with ischemic or nonischemic cardiomyopathy?
Long-term outcomes including total mortality, cardiac mortality, and HF hospitalization after CRT in patients with structural ACHD are similar to those in adults with ischemic or nonischemic cardiomyopathy.
Hazard Ratio: 0.38 (95% CI 0.15–0.91)
Absolute Event Rate: 21.7% vs 41.5%
BACKGROUND AND AIMS: Randomized, controlled trials of cardiac resynchronization therapy (CRT) excluded patients with adult congenital heart disease (ACHD). We sought to explore long-term clinical outcomes. METHODS AND RESULTS: In this single-center, observational study, events were collected from hospital records on patients with structural ACHD (sACHD) and adults with ischemic (ICM) or nonischemic (NICM) cardiomyopathy undergoing CRT. Patients with sACHD (n = 23, age: 41.6 ± 13.5 years mean ± standard deviation) and adults with ICM (n = 533) or NICM (n = 458) were followed-up for 4.1 years (median; interquartile range: 2.2-6.1). Total mortality was 5/23 (21.7%; 4.4 per 100 person-years) in sACHD, 221/533 (41.5%; 11.8 per 100 person-years) in ICM, and 154/458 (33.6%; 9.7 per 100 person-years) in NICM. In univariate analyses, total mortality in sACHD was lower than in ICM (hazard ratio HR: 0.38; 95% confidence interval CI 0.15-0.91), but similar to NICM (HR: 0.48, 95% CI 0.20-1.16). Cardiac mortality in sACHD was similar to ICM (HR: 0.78, 95% CI 0.32-1.92) and NICM (HR: 1.12, 95% CI 0.45-2.78). Heart failure (HF) hospitalization rates were similar to ICM (HR: 0.44, 95% CI 0.11-1.77) and NICM (HR: 0.75, 95% CI 0.18-3.08). In multivariate analyses, no differences emerged in total mortality, cardiac mortality, or HF hospitalization between sACHD and NICM or ICM, after adjustment for age, sex, New York Heart Association class, diabetes, atrial rhythm, QRS duration, QRS morphology, systemic ventricular ejection fraction, and medical therapy. CONCLUSION: Total mortality, cardiac mortality, and HF hospitalization after CRT in patients with sACHD was similar to adults with ICM or NICM.
Leyva et al. (Mon,) conducted a observational in Structural adult congenital heart disease and cardiomyopathy (n=1,014). Structural adult congenital heart disease vs. Ischemic or nonischemic cardiomyopathy was evaluated on Total mortality (HR 0.38, 95% CI 0.15-0.91). Structural adult congenital heart disease patients undergoing CRT had similar adjusted mortality to ischemic or nonischemic cardiomyopathy, despite lower unadjusted rates (21.7% vs 41.5% and 33.6%).