Heart failure & cardiomyopathies
Patient-Specific Modifiers of Survival Benefit in Cardiac Resynchronization Therapy - A Multicentre Interaction Analysis
Authors' conclusion
This study provides insights into the benefits of CRT-D over CRT-P, identifying LBBB morphology, LVEF and renal function as key covariates associated with implantable cardioverter-defibrillator (ICD) therapy's benefit.
Study context
- Population
- Patients undergoing cardiac resynchronization therapy (CRT) implantation for HF
- Participants
- 2,271 patients
- Exposure
- CRT-D vs CRT with pacemaker (CRT-P)
- Outcome
- All-cause mortality; interaction of clinical variables with CRT-D vs CRT-P benefit
Methodological detailsmulticentre, 3 European centres, interaction analysis (multivariable Cox models)
- Multicentre
- 3 European centres
- Interaction analysis (multivariable Cox models)
Main finding
As reported in the abstract
All-cause mortality, effect modification by patient characteristics
CRT-D vs CRT-PHazard ratio (95% CI)P value
LBBB
0.57(0.44–0.73)
P = 0.028 for interaction (LBBB)No LBBB; not significant
0.81(0.59–1.10)
- Significant interaction with left ventricular ejection fraction (LVEF); CRT-D benefit for LVEF at implant between 17.9% and 37.6%
- P = 0.025
- Significant interaction with renal function; CRT-D benefit with eGFR >31.8 mL/min, not with more advanced renal impairment
- P = 0.019
- No interaction with age at implant
- P = 0.286
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortality, overall35% reduction | 0.65 (0.53–0.80) | |
| 0.512Hazard ratio (log scale) |
Original publication
Patient-Specific Modifiers of Survival Benefit in Cardiac Resynchronization Therapy - A Multicentre Interaction Analysis. ESC Heart Fail. Published 30 July 2025. doi:10.
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