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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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Risk stratification of heart failure patients submitted to cardiac resynchronization therapy using a combination of renal function and 123I-mIBG scintigraphy
Session:
Posters 5 - Écran 7 - Imagiologia Cardiovascular
Speaker:
Rita Loreto Ilhão Moreira
Congress:
CPC 2019
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.4 Nuclear Imaging
Session Type:
Posters
FP Number:
---
Authors:
Rita Ilhão Moreira; Ana Abreu; Madalena Coutinho Cruz; Dra. Inês Rodrigues; Guilherme Portugal; Tânia Branco Mano; Luís Oliveira; Mário Martins Oliveira; Pedro Silva Cunha; Vanessa Santos; Helena Santa Clara; Miguel Mota Carmo; Rui Cruz Ferreira
Abstract
<p><strong>Background: </strong>Renal dysfunction and cardiac autonomic denervation as assessed by <sup>123</sup>I-metaiodobenzylguanidine (<sup>123</sup>I-mIBG) scintigraphy are both associated with poor prognosis in heart failure (HF) patients (pts). However, their incremental prognostic values in HF pts undergoing cardiac resynchronization therapy (CRT) is unclear.</p> <p><strong>Aims: </strong>We sought to assess the prognostic value of baseline renal dysfunction and cardiac autonomic denervation among CRT pts.</p> <p><strong>Methods: </strong>Prospective unicentric study including consecutive HF pts submitted to CRT who underwent clinical, laboratorial, echocardiographic and scintigraphic assessment before and 6 months after device implantation. Renal dysfunction was defined as pre-implantation estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m<sup>2</sup>. Cardiac autonomic denervation was defined as pre-implantation <sup>123</sup>I-mIBG late heart-to mediastinum (HMR) below 1.4. Patients were classified into 3 groups: high (both renal dysfunction and autonomic denervation), intermediate (either renal dysfunction or autonomic denervation) or low risk (neither renal dysfunction nor autonomic denervation). Composite outcome was defined as cardiac mortality, cardiac transplant or heart failure hospitalization.</p> <p><strong>Results: </strong>A total of 119 patients were included (69.23 ± 11.38 years; 68.1% male; 74.8% in class III of NYHA classification; 31.4% with ischemic cardiomyopathy; LV ejection fraction [LVEF] 26.03 ± 6.99%; 35% with atrial fibrillation). During follow-up (mean 25.5 ± 12.9 months), composite endpoint was documented in 29 pts (24.4%), corresponding to 11.5% per year. Multivariate Cox proportional hazards regression showed that eGFR and late HMR were independent predictors of composite outcome (HR 0.983, 95% CI 0.970-0.997, p 0.017 and HR 0.066, 95% CI 0.005-0.880, p 0.040, respectively). The composite endpoint of pts in high, intermediate and low risk groups according to renal and autonomic dysfunction was 36.7%, 24.5% and 12.1%, respectively (HR 22.487, 95% CI 3.155-160.262, p 0.002, fig. 1). Late HMR remained an important independent predictor of prognosis in the sub-group of pts with renal dysfunction (HR 0.002, 95% CI 0.001-0.753, p 0.040).</p> <p><strong>Conclusion: </strong>Combined baseline renal dysfunction and cardiac autonomic denervation provide a significant prognostic value among CRT pts.</p>
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