SPC365

Cardiac resynchronization therapy in severe heart failure Patients: The role of ARNIs in the Modern Therapeutic Landscape

Session: SESSÃO DE POSTERS 49 - RESSINCRONIZAÇÃO CARDÍACA E TERAPÊUTICA MÉDICA
Speaker: Inês Ferreira Neves

Congress: CPC 2025
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Inês Ferreira Neves; Francisco Cardoso; Julien Lopes; Hélder Santos; Guilherme Portugal; Pedro Silva Cunha; Bruno Valente; Ana Lousinha; Rita Moreira; António Gonçalves; Rui Cruz Ferreira; Mário Martins Oliveira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Introduction:</span></strong><span style="font-size:10.0pt"> Cardiac resynchronization therapy (CRT) is recommended for symptomatic Heart Failure (HF) patients (P) with a QRS duration &ge;150 ms, left bundle branch block&nbsp;QRS morphology, and left ventricular ejection fraction (LVEF) &le;35% despite guideline directed medical therapy (GDMT), to improve symptoms and decrease morbidity and mortality. However, the trials responsible for the inclusion of this indication in the guidelines predate the use of angiotensin receptor-neprilysin inhibitors (ARNIs). Whether the benefit of implanting a CRT with the contemporary available medication is maintained is not known.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Methods: </span></strong><span style="font-size:10.0pt">Consecutive P with HF&nbsp;and reduced Ejection Fraction (HFrEF), symptomatic, with Left Ventricular Ejection Fraction (LVEF) &le;35% after 3 months of GDMT and a prolonged QRS submitted to CRT implantation for primary prevention at our center between 2015 and 2022 were included. Patients with an existing pacemaker or Implantable Cardioverter Defibrillator (ICD) who develop a clinical indication for CRT were also included.<strong> </strong>A paired-sample T-test analysis was performed to evaluate pre- and post-device implantation metrics in two groups: P medicated with ARNI and P not medicated with ARNI at the time of device implantation. Primary endpoints included changes in NYHA functional class, LVEF, and left ventricular end-systolic volumes. The <em>odds</em> of HF hospitalization and survival curves were&nbsp;calculated.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Results: </span></strong><span style="font-size:10.0pt">Out of 158 P (mean age 67.5&plusmn;9.1, 115 [72.8%] male) included, 46 (29.1%) were medicated with ARNI at the moment of device implantation. Mean follow-up time was 54&plusmn;28.9 months. </span></span></span><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">In the group not medicated with ARNI when submitted to device implantation, NYHA functional class improved by 0.64 after one year (95% CI: 0.50&ndash;0.78, p &lt; 0.001), LVEF increased significantly by 13.28% (95% CI: -15.85 to -10.71, p &lt; 0.001), and LVESV decreased by 38.53 mL (95% CI: 25.79&ndash;51.28, p &lt; 0.001. In the ARNI-treated group, similar trends were noted. NYHA class improved by 0.72 points (95% CI: 0.50&ndash;0.94, p &lt; 0.001), LVEF increased by 9.60% (95% CI: -13.39 to -5.81, p &lt; 0.001), and LVESV decreased by 29.25 mL (95% CI: 0.55&ndash;57.95, p = 0.046).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">In the logistic regression, the use of ARNI was not a significant predictor of hospitalization due to HF (<em>odds ratio</em> 0.721 (95% CI: 0.308&ndash;1.686, p = 0.450). Among the ARNI-treated group, 15.6% were hospitalized due to HF, compared to 40.2% in the non-ARNI group.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">The Kaplan-Meier analysis demonstrated a non-statistically significant higher survival in patients medicated with ARNI (p = 0.291).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Conclusion:</span></strong><span style="font-size:10.0pt"> CRT significantly improves functional class, LVEF, and LVESV in HFrEF patients, irrespective of ARNI use at the time of implantation, suggesting that its benefit is maintained in the era of new pharmacotherapy. Although ARNI-treated patients showed trends toward lower HF hospitalization rates and improved survival, these differences were not statistically significant.</span></span></span></p>