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Right ventricular dysfunction is a predictor of non-response to cardiac resynchronization therapy
Session:
CO 08 - Insuficiência cardíaca crónica
Speaker:
Tamara Pereira
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:
---
Authors:
Tamara Pereira; Pedro Von Hafe Leite; Geraldo Dias; Ana Filipa Cardoso; Mariana Tinoco; Olga Azevedo; Mário Lourenço; Sílvia Ribeiro; Francisco Ferreira; Víctor Sanfins; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">INTRODUCTION: Cardiac resynchronization therapy (CRT) has been of great benefit to many heart failure (HF) patients with reduced ejection fraction (EF) and intraventricular conduction delay. However, approximately </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">30% of patients fail to respond to CRT. </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">We investigated baseline </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">characteristics that might influence response to CRT.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">METHODS: </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">We retrospectively enrolled 227 patients undergoing CRT implantation between 2013 and 2020 according to the <em>guidelines</em></span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">. 118 patients were included in our analysis, from whom all data were available. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and 6 months after CRT implantation. Response to CRT was defined as an increase in left ventricular ejection fraction (LVEF) >10%. Right ventricular systolic dysfunction (RVSD) was defined as S’ velocity <9.5 cm/s or tricuspid anular plane systolic excursion (TAPSE) <17 mm. Chronic kidney disease (CKD) was defined as <span style="background-color:white">GFR <60 ml/min/1.73m<sup>2</sup></span></span></span><sup><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:#4d5156">.</span></span></span></sup><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:#4d5156">. </span></span></span><br /> <br /> <span style="font-family:"Calibri Light",sans-serif"><span style="color:black">RESULTS: </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">118 patients were included (mean age 69 ± 11 years, 66.1% males, 39.8% ischemic etiology; 35,6% atrial fibrillation, </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">baseline LVEF 27,6 ± 6%).</span></span><br /> <span style="font-family:"Calibri Light",sans-serif"><span style="color:black">After 6 months of CRT, 65 patients (55.1%) were considered responders.<br /> Responders were more frequently female than non responders (43,1% vs 22,6, p=0.02). Atrial fibrillation and CKD were more prevalent in non responders (47,2% vs 26,2%, p= 0.018; 62,3% vs 21,5%, p<0.001, respectively). </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">RVSD was present in 60,4% of non responders vs 16,9% of responders (p<0.001</span></span><u><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">)</span></span></u><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">.</span></span> <span style="font-family:"Calibri Light",sans-serif"><span style="color:black">In responder group, <span style="background-color:white">the <em><span style="font-family:"Calibri Light",sans-serif">mean S</span></em>' <em><span style="font-family:"Calibri Light",sans-serif">velocity</span></em></span> was 10,9 ± 2,1 cm/s <em>vs </em>9,1 ± 2,1 cm/s in non responder group, p< 0.001. The mean TAPSE was also higher in responder group (20,3 ± 7,2 mm vs 16,5 ± 4,4 mm, p=0.031).<br /> On multivariate analysis only RVSD (OR 7,754; 95% CI 2,968 – 20,282 p<0.001] and CKD (OR 5,434; 95% CI 2,109 – 14,002; p<0.001) were independently associated with non-response to CRT.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">CONCLUSION: From a range of preoperative characteristics, multivariate analysis only identified RVSD and CKD as independent predictors of CRT response, with S’ <9,5 </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">cm/s and TAPSE <17 mm </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">associated with non-response to CRT. This study highlights the importance of routine RV assessment in order to improve</span></span><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> <em><span style="font-family:"Calibri Light",sans-serif">patient selection</span></em> and optimize <em><span style="font-family:"Calibri Light",sans-serif">CRT</span></em> response in heat failure patients.</span></span></span></span></span></span></p>
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