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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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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Dilated cardiomyopathy - a group that does not benefit from ICD?
Session:
Posters 1 - Écran 3 - Arritmologia
Speaker:
Pedro Silvério António
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Pedro Silvério António; Afonso Nunes Ferreira; João Pedro Ribeiro Agostinho; Inês Aguiar Ricardo; Joana Rigueira; Rafael Santos; Tiago Graça Rodrigues; Nelson P. Cunha; Pedro Morais; Fausto José Pinto; João Rodrigues De Sousa; Pedro Nuno Carlos Marques
Abstract
<p><strong>Introduction</strong>: The prevalence of sudden death in patients with heart failure with reduced ejection fraction has been declining in the last decade, not only due to better optimization of pharmacological therapy, but also due to the high rate of cardiac resynchronization responders. Overall, based on recent studies demonstrating a lack of improvement in mortality in some patients with dilated cardiomyopathy, the CRT-P/CRT-D implantation ratio has been increasing across Europe.</p> <p><strong>Objective</strong>: To evaluate the evolution of the CRT-P/CRT-D implantation ratio and to evaluate the impact on mortality of dilated cardiomyopathy (DCM) patients who underwent resynchronization therapy.</p> <p><strong>Methods</strong>: A single-center prospective study of non-randomized patients who underwent CRT implantation since 2015. Demographic and clinical data from patients with dilated cardiomyopathy were assessed. The mortality of these patients and the predictors of mortality by the Cox and Kaplan-Meier regression method were evaluated.</p> <p><strong>Results</strong>: 486 CRTs were implanted since 2015 (male 73.9%, age 72.06 ± 9.9 years, median follow-up time of 487 days IIQ [175, 749].) During the last 3 years, occurred an increased in CRT-P/CRT-D ratio with the CRT-P implant rate increasing from 36% of the total devices in 2015 to 47% in 2018. </p> <p>Of the patients submitted to CRT implantation, 256 (55%) had dilated cardiomyopathy as the etiology of heart failure. In this population, by multivariate Cox analysis, age (HR 1.1, 95% CI 1.0-1.1, p = 0.003) and GFR <60ml/min/1.73m2 (HR 1.8 IC 95% 1, 2-2.6, p = 0.01) were independent predictors of mortality. In addition, CRT-D implantation in these patients was associated with a significant reduction in all-cause mortality (HR 0.33 95% CI 0.15-0.73, p <0.01) with a required number to treat only 10 patients. Similar results were obtained in the subgroup of patients aged ≥ 59 years.</p> <p><strong>Conclusion</strong>: The CRT-P implant rate has been increasing at the expense of the CRT-D implant after some studies suggest no benefit in the population aged ≥ 59 years. However, in our population of patients with DCM, CRT-D implantation demonstrated a 67% mortality reduction. These results may demonstrate a good selection of patients for this therapy, but should also motivate further studies in the evaluation of mortality in this subgroup of patients.</p>
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