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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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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Heart failure and mortality in atrial fibrillation patients after cardiac resynchronization therapy
Session:
CO5 - Insuficiência Cardíaca
Speaker:
Ricardo Costa
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ricardo Costa; Raquel Baggen Santos; Maria Trêpa; Marta Fontes Oliveira; André Dias De Frias; Maria J. Sousa; Carla Roque; Antonio Vieira; Vitor Lagarto; António Hipólito Reis; Mário Silva Santos; Severo Torres
Abstract
<p><strong>Introduction: </strong>Atrial fibrillation (AF) is associated with a diminished response to cardiac resynchronization therapy (CRT) in patients with heart failure with reduced ejection fraction (HFrEF). We aimed to compare the rate of heart failure (HF) hospitalizations and all-cause mortality between patients with and without AF, submitted to CRT.</p> <p><strong>Methods: </strong>We retrospectively studied consecutive HF-patients with left ventricular ejection fraction (LVEF) =35%, New York Heart Association (NYHA) class ≥II and QRS =130 milliseconds submitted to CRT at a tertiary hospital between January 2002 and March 2016. Clinical and outcome data were retrieved by review of the patient’s records.</p> <p><strong>Results: </strong>We included 264 patients with 69±10 years old, 68% were male. Pre-CRT rhythm was sinus rhythm (SR) in 50% of the individuals, paroxysmal AF in 17% and permanent AF in 33%. The group of patients with permanent AF had a higher proportion of male gender (<em>p</em>=0.011) and baseline NYHA class was higher in the two groups with AF (<em>p</em>=0.005). Biventricular pacing percentage was inferior in patients with permanent AF (SR: 98%, paroxysmal AF: 97%, permanent AF: 93%, <em>p</em><0.001). Mean increase of LVEF was similar between groups: 9±11% in SR, 7±10% in paroxysmal AF and 8±11% in permanent AF (<em>p</em>=0.365). There were no significant differences in NYHA functional class improvement after CRT (SR: 71%, paroxysmal AF: 79%, permanent AF: 71%, <em>p</em>= 0.556). The rate of post-CRT HF hospitalizations, during a median follow-up time of 32.5 [14-64.8] months, was higher in patients with permanent AF, with a 5-year event rate of 36%, while in patients without permanent AF was 21.2% (log rank test <em>p</em>=0.016). In multivariate analysis, permanent AF was not independently associated with HF hospitalization (<em>p</em>=0.737); only post-CRT LVEF (HR 0.91, 95 CI 0.86-0.96) and post-CRT NYHA class (if ≥III, HR 4.33, 95% CI 1.82-10.31) were independent predictors. Overall post-CRT mortality was 34%, with a median time to event of 40 [12-67.5] months. Survival time was worse in patients with permanent AF (log rank test <em>p</em>=0.02). Only age (HR 1.05, 95 CI 1.02-1.10), diabetes (HR 2.14, 95% CI 1.09-4.20) and post-CRT LVEF (HR 0.93, 95 CI 0.90-0.97) were independent predictors of death.</p> <p><strong>Conclusion:</strong> Despite the overall worse prognosis compared to patients in SR and paroxysmal AF, permanent AF was not independently associated with HF hospitalization and mortality in this HFrEF cohort undergoing CRT. </p>
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