{"id":"3d6614975a1a","type":"article","url":"https://hartvaat.nl/2017/05/16/comorbiditeiten-en-crt-respons-madit-crt-langetermijnfollow-up/","title":"Comorbiditeiten en CRT-respons: MADIT-CRT langetermijnfollow-up","title_en":"Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.03.531","source_url":"https://doi.org/10.1016/j.jacc.2017.03.531","authors":["Emily P Zeitler","Daniel J Friedman","James P Daubert","Sana M Al-Khatib","Scott D Solomon","Yitschak Biton","Scott McNitt","Wojciech Zareba","Arthur J Moss","Valentina Kutyifa"],"significance":6,"published":"2017-05-16","source_date":"2017-05-16","image":"","kennis":[],"congress":"","summary_en":"This MADIT-CRT long-term analysis demonstrated that multiple comorbidities attenuate the response to CRT but do not eliminate the benefit, informing patient selection for cardiac resynchronization in the presence of competing conditions.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T13:26:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"MADIT-CRT langetermijnanalyse naar de invloed van multipele comorbiditeiten op de respons op CRT. Comorbiditeiten verminderen het voordeel van resynchronisatietherapie.","abstract_original":"BACKGROUND: Data regarding cardiac resynchronization therapy (CRT) in patients with multiple comorbidities are limited. OBJECTIVES: This study evaluated the association of multiple comorbidities with the benefits of CRT over implantable cardioverter-defibrillator (ICD) alone. METHODS: We examined 1,214 MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) study patients with left bundle branch block (LBBB) and 0, 1, 2, or ≥3 comorbidities, including renal dysfunction, hypertension (HTN), diabetes, coronary artery disease, history of atrial arrhythmias, history of ventricular arrhythmias, current smoking, and cerebrovascular accident. In an adjusted analysis, we analyzed risk of heart failure (HF) events or death by comorbidity group in all patients and in patients with CRT with defibrillator (CRT-D) versus ICD. Then we examined percent change in left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV ejection fraction, left atrial volume, and LV dyssynchrony at 1-year in CRT-D patients by comorbidity group. RESULTS: There was an inverse relationship between comorbidity burden and improvements in LV end-systolic volume, LV end-diastolic volume, left ventricular ejection fraction, left atrial volume, and LV dyssynchrony. In an adjusted model, there was an increasing risk of death or nonfatal HF events with increasing comorbidity burden regardless of treatment group (p < 0.001). During a mean follow-up of 4.65 years, there was no interaction with respect to comorbidity burden and the benefit of CRT-D versus ICD only for death or nonfatal HF events (interaction p = 0.943). In the groups with greatest comorbidity burden (2 and ≥3), the absolute risk reduction associated with CRT-D over ICD alone appeared greater than that seen for groups with less comorbidity burden (0 and 1). CONCLUSIONS: During long-term follow-up of MADIT-CRT study patients with LBBB randomized to CRT-D, there were differences in HF or death risk and in the degree of reverse remodeling among comorbidity groups. However, the burden of comorbidity does not appear to compromise the clinical benefits of CRT-D compared with ICD alone."}