Disclosures: The authors have no conflicts to disclose.
Effectiveness of Cardiac Resynchronization Therapy with Defibrillator in At-Risk Black and White Cardiac Patients
Article first published online: 22 NOV 2012
©2012, Wiley Periodicals, Inc.
Annals of Noninvasive Electrocardiology
Volume 18, Issue 2, pages 140–148, March 2013
How to Cite
Elanchenny, M., Moss, A. J., McNitt, S., Aktas, M., Polonsky, S., Zareba, W. and Goldenberg, I. (2013), Effectiveness of Cardiac Resynchronization Therapy with Defibrillator in At-Risk Black and White Cardiac Patients. Annals of Noninvasive Electrocardiology, 18: 140–148. doi: 10.1111/anec.12006
- Issue published online: 26 MAR 2013
- Article first published online: 22 NOV 2012
- cardiac resynchronization therapy;
- heart failure;
There are limited data regarding racial differences in response to cardiac resynchronization therapy with defibrillator (CRT-D).
We assessed the effectiveness of CRT-D, as compared to implantable cardioverter defibrillator (ICD) therapy alone, in reducing the risk of heart failure (HF) or death and changes in cardiac volumes among 1638 (90%) white patients and 143 (8%) black patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT).
Enrolled black patients displayed a higher frequency of diabetes mellitus, treated hypertension, higher creatinine levels, and a lower distance walked in the baseline 6-minute walk test. Kaplan-Meier survival analysis showed that at 3 years of follow-up the cumulative probability of HF or death was higher among blacks (29%) as compared with whites (22%; P = 0.05). Both black and white patients experienced similar and pronounced reductions in cardiac volumes with CRT-D therapy (all P values for comparison between the two groups >0.10). Risk reduction conferred by CRT-D therapy as not significantly different between blacks and whites (hazard ratio = 0.78 and 0.60, respectively; P for the difference = 0.44). However, possibly due to sample size limitations the CRT-D versus ICD only adjusted risk for HF/death in blacks was not statistically significant.
Black patients in MADIT-CRT experienced increased risk of HF or death as compared with whites, but displayed a similar magnitude echocardiographic response to CRT-D. These findings suggest that cardiac resynchronization therapy may be an effective therapeutic modality in black patients. However, further studies are needed to assess the clinical response to CRT-D in this high-risk population.