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Outcomes and predictors of clinical response after upgrade to resynchronization therapy
Session:
CO 23 - Dispositivos
Speaker:
Mariana Silva Brandão
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
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Authors:
Mariana S. Brandão; João Gonçalves Almeida; Paulo Fonseca; Joel Monteiro; Filipa Rosas; Elisabeth Santos; José Ribeiro; Marco Oliveira; Helena Gonçalves; João Primo; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>BACKGROUND: </strong>Upgrade to resynchronization therapy (CRT) is common practice in Europe. However, patient selection remains a challenge. Data regarding predictors of response to upgrade is currently lacking.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>AIM: </strong>To identify predictors of clinical response after upgrade to CRT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS: </strong>Single-center retrospective study of consecutive patients submitted to upgrade to CRT (2007-2018). Patients underwent clinical and echocardiographic (echo) evaluation at baseline, 6-months and 1-year. Major adverse cardiac events (MACE) included hospitalization for heart failure (HF) or all-cause mortality. Clinical response was defined as New York Heart Association (NYHA) class improvement without MACE in the 1<sup>st</sup> year of follow-up (FU). Left ventricle end-systolic volume reduction of >15% designated echo response. Multivariate logistic regression was performed to identify predictors of clinical response to CRT. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS: </strong>Fifty-six patients submitted to upgrade to CRT (80.4% male, mean age 70.0±9.6 years) were included; 43 patients (78.2%) previously had a pacemaker and 12 (21.8%) had a defibrillator device. Most patients had non-ischemic HF (67.9%), with a mean baseline left ventricle (LV) ejection fraction of 27.9±6.4%. Indications for upgrade were mainly pacemaker dependency or pacing-induced LV dysfunction (76.6%) and <em>de novo</em> left bundle branch block (23.4%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Thirty-one (59.3%) patients were clinical responders. MACE occurred in 37.5% of patients; 28.6% were hospitalized for HF and 13% died during the 1<sup>st</sup> year of FU. Clinical responders had a lower rate of atrial fibrillation (AF) (46.9% <em>vs.</em> 53.1%, p=.025) and a higher rate of pacemaker rhythm prior to upgrade (80.6% <em>vs </em>47.6%, p=.013). Among responders, the previous device was more frequently a pacemaker (87.5% <em>vs </em>61.9%, p=.029), and the new device a CRT-P (81.2% <em>vs </em>54.5%, p=.035). HF etiology did not differ between responders and non-responders.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Multivariate analysis identified absence of AF (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-17.6, p=.037), CRT-P (OR 5.7, 95% CI 1.3-25.8, p=.022) and quadripolar lead implant (OR 3.8, 95% CI 1.3-25.8, p=.024) as predictors of clinical response in upgraded patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSIONS:</strong> In this cohort, absence of AF, implantation of CRT-P and use of a quadripolar lead predicted clinical response to upgrade to CRT. Larger studies are warranted to tailor selection of patients for upgrade procedures.</span></span></p> <p style="text-align:justify"> </p>
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