Background
Method
Study patients
Baseline evaluation and data collection
CRT implantation and follow-up
Definition of hypothyroidism and euthyroidism
Statistical analysis
Variable | All (n = 1316) | Euthyroidism (n = 966) | Hypothyroidism (n = 350) | P Value |
---|---|---|---|---|
Age, y | 69.8 ± 12.2 | 69.3 ± 12.4 | 71.2 ± 11.2 | 0.01 |
Female | 289 (22.0) | 184 (19.0) | 105 (30.0) | < 0.001 |
CRT-D | 1181 (89.7) | 867 (89.7) | 314 (90.0) | 0.87 |
Primary prevention | 979 (82.9) | 749 (86.5) | 230 (73.0) | < 0.001 |
Hypertension | 539 (41.0) | 398 (41.2) | 141 (40.4) | 0.81 |
Diabetes mellitus | 398 (30.2) | 297 (30.7) | 101 (28.9) | 0.54 |
Chronic kidney disease | 357 (27.1) | 248 (25.7) | 109 (31.2) | 0.04 |
Hyperlipidemia | 600 (45.7) | 442 (45.7) | 158 (45.4) | 0.92 |
Atrial fibrillation history | 599 (44.5) | 430 (44.5) | 169 (48.4) | 0.20 |
ICM | 632 (48.0) | 462 (47.8) | 170 (48.7) | 0.77 |
LBBB | 644 (40.1) | 491 (52.2) | 153 (44.5) | 0.02 |
QRS duration, ms | 170.2 ± 28.5 | 169.5 ± 28.2 | 172.1 ± 29.4 | 0.16 |
NYHA functional class, 1–4 | 2.8 ± 0.6 | 2.8 ± 0.6 | 2.9 ± 0.5 | 0.64 |
3–4 | 892 | 644 (69.7) | 248 (73.6) | |
2 | 349 | 264 (28.6) | 85 (25.2) | |
1 | 20 | 16 (1.7) | 4 (1.2) | |
LVEF, % | 24.3 ± 6.5 | 24.2 ± 6.6 | 24.4 ± 6.6 | 0.62 |
TRT | 254 (19.3) | 0 (0) | 254 (72.9) | < 0.001 |
Amiodarone | 232 (17.6) | 135 (14.0) | 97 (27.9) | < 0.001 |
Statin | 705 (53.6) | 529 (54.7) | 176 (50.4) | 0.17 |
Digoxin | 539 (41.0) | 391 (40.4) | 148 (42.4) | 0.52 |
β-blocker | 1156 (87.8) | 853 (88.2) | 303 (86.8) | 0.50 |
ACEI/ARB | 1054 (80.1) | 781 (80.8) | 273 (78.2) | 0.31 |
Aldactone | 391 (29.7) | 288 (29.8) | 103 (29.5) | 0.93 |
Furosemide | 886 (67.3) | 640 (66.2) | 246 (70.5) | 0.14 |
Results
Baseline characteristics
Improvement in HF after CRT
All-cause mortality
Variable | Univariate Analysis | Multivariate Analysisa | Multivariate Analysisb | ||||||
---|---|---|---|---|---|---|---|---|---|
HR | 95% CI | P Value | HR | 95% CI | P Value | HR | 95% CI | P Value | |
Age | 1.04 | 1.04–1.05 | < 0.001 | 1.04 | 1.03–1.06 | < 0.001 | 1.04 | 1.03–1.06 | < 0.001 |
Female | 0.54 | 0.44–0.68 | < 0.001 | 0.73 | 0.52–1.04 | 0.09 | 0.77 | 0.53–1.12 | 0.18 |
CRT-D | 0.71 | 0.56–0.91 | 0.007 | 0.72 | 0.47–1.12 | 0.14 | 0.74 | 0.45–1.22 | 0.23 |
Hypertension | 0.97 | 0.83–1.14 | 0.73 | ||||||
Diabetes mellitus | 1.49 | 1.26–1.76 | < 0.001 | 1.77 | 1.35–2.31 | < 0.001 | 1.84 | 1.35–2.49 | < 0.001 |
Chronic kidney disease | 2.46 | 2.09–2.89 | < 0.001 | 1.47 | 1.12–1.93 | 0.006 | 1.45 | 1.07–1.98 | 0.02 |
Hyperlipidemia | 0.99 | 0.85–1.16 | 0.94 | ||||||
Atrial fibrillation | 1.33 | 1.13–1.55 | < 0.001 | 1.18 | 0.91–1.53 | 0.20 | 1.07 | 0.79–1.43 | 0.67 |
ICM | 2.02 | 1.71–2.38 | < 0.001 | 1.14 | 0.86–1.50 | 0.36 | 1.15 | 0.856–1.57 | 0.37 |
LBBB | 0.70 | 0.60–0.83 | < 0.001 | 0.75 | 0.58–0.97 | 0.03 | 0.78 | 0.58–1.05 | 0.11 |
QRS duration | 1.00 | 0.99–1.00 | 0.63 | ||||||
NYHA functional class | 1.95 | 1.66–2.30 | < 0.001 | 1.30 | 1.01–1.68 | 0.05 | 1.24 | 0.93–1.65 | 0.14 |
LVEF | 0.99 | 0.98–1.00 | 0.064 | 0.98 | 0.96–1.00 | 0.03 | 0.98 | 0.96–1.00 | 0.10 |
TRT | 1.38 | 1.14–1.67 | 0.001 | 1.20 | 0.71–2.04 | 0.50 | 1.43 | 1.02–2.02 | 0.04 |
Amiodarone | 1.33 | 1.09–1.61 | 0.005 | 1.20 | 0.87–1.66 | 0.27 | 1.25 | 0.89–1.76 | 0.20 |
Statin | 1.05 | 0.90–1.23 | 0.54 | ||||||
Digoxin | 1.31 | 1.12–1.54 | 0.001 | 1.42 | 1.10–1.85 | 0.008 | 1.46 | 1.09–1.95 | 0.01 |
b-Blocker | 0.90 | 0.71–1.15 | 0.41 | ||||||
ACEI/ARB | 0.67 | 0.55–0.81 | < 0.001 | 0.86 | 0.61–1.23 | 0.41 | 0.76 | 0.52–1.11 | 0.16 |
Aldactone | 1.00 | 0.84–1.18 | 0.96 | ||||||
Furosemide | 1.36 | 1.14–1.64 | 0.001 | 1.26 | 0.93–1.71 | 0.14 | 1.3 | 0.91–1.86 | 0.15 |
CRT response | 0.41 | 0.32–0.52 | < 0.001 | 0.42 | 0.32–0.54 | < 0.001 | 0.45 | 0.33–0.60 | < 0.001 |
Hypothyroidism | 1.37 | 1.15–1.62 | < 0.001 | 1.16 | 0.72–1.89 | 0.54 | – | – | – |
TSH per 5 mIU/L | 1.41 | 1.29–1.55 | < 0.001 | – | – | – | 0.94 | 0.74–1.19 | 0.60 |
Appropriate ICD therapy
Variable | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
HR | 95% CI | P Value | HR | 95% CI | P Value | |
Age | 0.99 | 0.98–1.00 | 0.08 | |||
Female | 0.41 | 0.29–0.59 | < 0.001 | 0.45 | 0.27–0.75 | 0.002 |
Primary prevention | 0.54 | 0.40–0.72 | < 0.001 | 0.28 | 0.10–0.83 | 0.02 |
Hypertension | 1.04 | 0.81–1.32 | 0.78 | |||
Diabetes mellitus | 1.01 | 0.78–1.32 | 0.92 | |||
Chronic kidney disease | 1.24 | 0.94–1.63 | 0.13 | |||
Hyperlipidemia | 1.09 | 0.86–1.39 | 0.48 | |||
Atrial fibrillation | 1.20 | 0.94–1.53 | 0.14 | |||
ICM | 1.13 | 0.89–1.44 | 0.32 | |||
LBBB | 0.67 | 0.52–0.85 | 0.001 | 0.72 | 0.50–1.05 | 0.08 |
QRS duration | 0.997 | 0.992–1.001 | 0.17 | |||
NYHA functional class | 1.16 | 0.91–1.47 | 0.24 | |||
LVEF | 0.98 | 0.96–1.00 | 0.02 | 0.97 | 0.95–1.01 | 0.11 |
TRT | 0.97 | 0.71–1.32 | 0.84 | |||
Statin | 1.02 | 0.80–1.30 | 0.87 | |||
amiodarone | 1.62 | 1.22–2.15 | 0.001 | 0.44 | 0.16–1.27 | 0.13 |
Digoxin | 1.55 | 1.22–1.97 | < 0.001 | 1.44 | 1.00–2.07 | 0.05 |
ACEARB | 0.77 | 0.57–1.05 | 0.09 | 0.73 | 0.45–1.18 | 0.20 |
Aldactone | 1.07 | 0.82–1.38 | 0.62 | |||
Furosemide | 1.30 | 0.99–1.71 | 0.06 | 1.13 | 0.75–1.70 | 0.54 |
CRT response | 0.43 | 0.32–0.59 | < 0.001 | 0.46 | 0.32–0.68 | < 0.001 |
TSH per 5 mIU/L | 1.05 | 1.02–1.09 | 0.002 | 1.23 | 1.01–1.50 | 0.04 |
Variable | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
HR | 95% CI | P Value | HR | 95% CI | P Value | |
Age | 0.99 | 0.97–1.01 | 0.42 | |||
Female | 0.33 | 0.17–0.64 | 0.001 | 1.59 | 0.66–3.86 | 0.30 |
Primary prevention | 0.46 | 0.28–0.74 | 0.002 | 0.15 | 0.02–1.21 | 0.07 |
Hypertension | 0.85 | 0.53–1.38 | 0.52 | |||
Diabetes mellitus | 0.79 | 0.45–1.38 | 0.41 | |||
Chronic kidney disease | 1.90 | 1.16–3.11 | 0.01 | 1.81 | 0.95–3.48 | 0.07 |
Hyperlipidemia | 0.75 | 0.47–1.22 | 0.25 | |||
Atrial fibrillation | 1.18 | 0.74–1.89 | 0.48 | |||
ICM | 1.60 | 0.98–2.59 | 0.06 | 0.99 | 0.51–1.95 | 0.98 |
LBBB | 0.74 | 0.46–1.19 | 0.22 | |||
QRS duration | 1.00 | 0.99–1.01 | 0.78 | |||
NYHA functional class | 1.31 | 0.80–2.17 | 0.29 | |||
LVEF | 0.99 | 0.95–1.03 | 0.55 | |||
TRT | 0.74 | 0.45–1.23 | 0.25 | |||
amiodarone | 1.79 | 1.10–2.89 | 0.02 | 0.36 | 0.05–2.81 | 0.33 |
Statin | 1.14 | 0.71–1.83 | 0.57 | |||
Digoxin | 1.03 | 0.64–1.65 | 0.91 | |||
b-Blocker | 0.87 | 0.45–1.65 | 0.66 | |||
ACEI/ARB | 0.78 | 0.45–1.36 | 0.39 | |||
Aldactone | 0.68 | 0.39–1.17 | 0.16 | |||
Furosemide | 1.23 | 0.71–2.11 | 0.46 | |||
CRT Response | 0.44 | 0.24–0.80 | 0.007 | 0.58 | 0.31–1.12 | 0.11 |
TSH per 5 mIU/L | 1.35 | 1.12–1.63 | 0.002 | 1.44 | 1.13–1.84 | 0.004 |