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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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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Cardiac resynchronization therapy failed to show impact on survival in the presence of high competing non-cardiovascular risk
Session:
Posters 4 - Écran 10 - Insuficiência Cardíaca
Speaker:
José Maria Farinha
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
José Maria Farinha; Leonor Parreira; Marta Ferreira Fonseca; Rita Marinheiro; Ana Fátima Esteves; Antonio Pinheiro Cumena Candjondjo; Dinis Valbom Mesquita; Pedro Campos Amador; Artur Lopes; Rui Caria
Abstract
<p><strong>Introduction</strong></p> <p>The indications for cardiac resynchronization therapy (CRT) have been frequently revisited. In our country, the CRT implantation is yet inferior to the European mean.</p> <p><strong>Objective</strong></p> <p>We aimed to study a population of patients fulfilling clinical, electrocardiographic, and echocardiographic criteria for CRT implantation, and to evaluate the reasons of non-implantation when it was not performed and the impact of non-implanting a CRT in patients with a high non-cardiovascular risk.</p> <p><strong>Methods</strong></p> <p>We retrospectively analysed all patients with a left ventricular ejection fraction (LVEF) ≤35% in echocardiogram, during the year 2014. We excluded patients already on CRT and those lost to follow-up. We selected those patients with indication for CRT implantation according to contemporary recommendations. We compared 2 groups: with CRT implanted and without CRT. The reason for non-implantation was specified. We analysed the baseline characteristics, and calculated the Charlson Comorbidity Index (CCI). During follow-up, we evaluated mortality and hospital admissions.</p> <p><strong>Results</strong></p> <p>We studied 43 patients with indication for CRT. Twelve implanted a CRT. Comparison between groups is presented in table. The reasons for non-implantation were mostly related to the presence of major comorbidities (48.4%), followed by symptomatic improvement after optimal medical therapy (OMT) readjustments (38.7%), lost follow-up (9.7%), and non-adherence to medical therapy (3.2%). Mean follow-up was 29.8 ± 14.1 months. Patients who did not implant a CRT were older, had a greater Charlson Comorbidity Index, and died more frequently because of non-cardiovascular causes (45.2% vs. 8.3%, <em>p</em>=0.033) (Table). Despite not statistically significant, patients without CRT also had a trend for a greater number of non-cardiovascular hospital admissions (Table).</p> <p><strong>Conclusions</strong></p> <p>In this group of patients, the non-cardiovascular mortality was significantly higher in those patients with a higher number of comorbidities. Probably these extremely debilitated patients will not benefit from CRT implantation.</p>
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