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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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32. Cardiovascular Nursing
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A super outcome to a super response
Session:
Posters 1 - Écran 01 - Arritmologia - Dispositivos
Speaker:
Ana Vera Marinho
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Ana Vera Marinho; James Milner; Patrícia M. Alves; Célia Domingues; João André Ferreira; Natália António; Luis Elvas; Francisco Gonçalves; Mariano Pêgo
Abstract
<p><strong>Introduction:</strong> In some heart failure patients, there is an exceptional improvement after cardiac resynchronization therapy (CRT), leading to an apparent recovery of left ventricular dysfunction – super-response. We aimed to compare long term prognosis between CRT super-responders and simple responders.</p> <p><strong>Methods:</strong> Retrospective single-institution study that included all patients submitted to CRT therapy between January 2006 and December 2015 that presented a positive response to CRT. Super response was defined as at least a duplication of baseline Left ventricular ejection fraction (LVEF) or LVEF >45%. Simple response was defined as an increase of 25-44% in LVEF. The primary endpoint was a combined endpoint including all-cause mortality, transplantation and heart failure (HF) admission. Secondary endpoints were the single components of the primary endpoint. Log rank test cox regression model were used to survival analysis</p> <p> <strong>Results:</strong> A total of 68 patients achieved a super-response (group 1) while 82 patients had criteria to be classified as simple responders (group 2). Age did not differ between groups [(62 (54-71) vs 65 (56-74) years, p=0.253)]. There were no differences between the distribution of Diabetes Mellitus (28% vs 24%, p=0.574), hypertension (54% vs 46%, p=0.531), dyslipidemia (61% vs 59%, p=0.521) and chronic kidney disease (31% vs 39%, p=0.626). Non-ischemic etiology was more prevalent in group 1 than in group 2, but this difference did not achieve statistical significance (84% vs 70%, p=0.06). The distribution of LBBB (82% vs 89%, p=0.402), and basal LV end diastolic volume [219(176-271) versus 222(179-273), p=0.867] was similar between groups. The median follow up was 57 (31-78) months. Mortality (12% vs 33%, p=0.01) and HF admissions (8.6% versus 17%, p=0.01) were significantly lower in super responders than in simple responders. Also, there was a trend toward lower Transplantation rate in super responders group1 (1.5% vs 4.8%, p=0.05). Regarding the combined endpoint, a super-response was associated with a higher event-free survival (HR 11.0 95%CI 76-99, p=0.001). A higher-event free survival was also found in group1 concerning each component of the primary endpoint: mortality (HR 12.2 CI 95% 62-121, p<0.001), HF admissions (HR 6.8, CI 95% 104-141, p=0.01).</p> <p><strong>Conclusion</strong>: This study highlights the importance to understand the mechanisms that underlie super-response to CRT as this is associated to better prognosis than simple response.</p>
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