Effect of serum gamma-glutamyltranferase and albumin levels on the response to cardiac resynchronization therapy in the elderly
Résumé
Background Several liver function tests have been identified as predictors of hospitalization for heart failure (HF) and death in patients with chronic HF. The relationship between serum gamma-glutamyltranferase (GGT) and albumin (SA) levels with the response to cardiac resynchronization therapy (CRT) has not been reliably determined. The aim of the study was to evaluate the impact of liver function tests on the results of CRT in the elderly. Methods Baseline GGT and SA were assessed before CRT device implantation in the elderly (> 70-year-old) patients. The endpoints were: (1) CRT response defined as > 5% left ventricular ejection fraction improvement and no hospitalization for HF or cardiovascular death; (2) hospitalizations; and (3) mortality. Results Eighty of 138 (58%) included patients were responders at nine months. Compared to responders, the SA levels were not significantly different (35.1 +/- 5.4 vs. 33.6 +/- 5.5 g/L, P = 0.103); but the GGT levels, higher (81.6 +/- 69.3 vs. 54.7 +/- 49.6 U/L, P = 0.013) in non-responders to CRT. GGT level was independently associated with non-response to CRT (P < 0.001, OR = 0.17; 95% CI: 0.08-0.38, P < 0.001). GGT cut-off value >= 55 U/L was highly predictive of non-response [AUC = 0.65, 64% Sensitivity, 69% Specificity (95% CI: 0.56-0.74)]. GGT >= 55 U/L was also associated with higher risk of hospitalization for atrial fibrillation (AF) (95% vs. 83%, P = 0.024). Both SA and GGT had no impact on overall (P = 0.220, P = 0.723) mortality. Conclusions Higher level of GGT is an independent predictor of non-response to CRT in patients over age 70 years and is associated with higher risk of hospitalization for AF. Baseline serum levels of albumin and GGT and have no impact on mortality in elderly patients undergoing CRT.