SPC365

The impact of glomerular filtration rate in patients with heart failure and Cardiovascular Implantable Electronic Devices

Session: Posters - C. Arrhythmias and Device Therapy
Speaker: Tiago Graça Rodrigues

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.3 Cardiac Resynchronization Therapy
Session Type: Posters
FP Number: ---
Authors: Tiago Graça Rodrigues; Afonso Nunes-Ferreira; Pedro Silvério-António; Mafalda Carrington; Nelson Cunha; Sara Pereira; Gustavo Lima da Silva; Andreia Magalhães; Luís Carpinteiro; Natacha Rodrigues; Fausto j. Pinto; João de Sousa; Pedro Marques
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><u><span style="font-size:11pt"><span style="color:black">Introduction</span></span></u><span style="font-size:11pt"><span style="color:black">: </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Heart Failure (HF) and chronic kidney disease (CKD) are both epidemic, frequently simultaneous and share well knowned risk factors. According to HF guidelines Cardiovascular Implantable Electronic Devices (CIED) can improve quality of life and reduce mortality in selected populations. KDIGO consensus, based on two meta-analyses, states that cardiac resynchronization therapy (CRT) or implantable cardiac defibrillator (ICD) benefit is only lost below stage 4 of CKD. However, little is known about the prognostic impact of glomerular filtration rate (GFR) across other stages of CKD of HF patients submitted to CIED implants.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><u><span style="font-size:11pt"><span style="color:black">Purpose</span></span></u><span style="font-size:11pt"><span style="color:black">: To evaluate the impact of CKD in all-cause mortality in HF patients who implanted a CIED.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><u><span style="font-size:11pt"><span style="color:black">Methods</span></span></u><span style="font-size:11pt"><span style="color:black">:</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Prospective single-center study of patients who implanted CRT or ICD between 2015 and 2019. Clinical characteristics were evaluated at baseline and mortality was assessed using the national registry. CKD was evaluated according to the GFR by KDIGO classification. We performed univariate and multivariate analysis to compare clinical characteristics of patients who died and who survived using the Cox regression and Kaplan-Meier methods. For the predictor GFR levels, and according to the KDIGO classification, we assessed the best cut-off value for mortality using the area under&nbsp;the ROC&nbsp;curve (AUC) method.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><u><span style="font-size:11pt"><span style="color:black">Results</span></span></u><span style="font-size:11pt"><span style="color:black">:</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">From 2015-2019, 974 devices were implanted, 414 ICDs and 560 CRTs (23.3% female, 67.6&plusmn;12.1, follow-up duration 26.4&plusmn;16.5 months). A total of 161 patients (16.5%) died during follow-up. GFR at the time of device implant was significantly lower in patients who died compared to those who survived (49.7 vs 67.3ml/min/1.73m</span></span><sup><span style="font-size:7pt"><span style="color:black">2</span></span></sup><span style="font-size:11pt"><span style="color:black">, p&lt;0.001). When evaluating predictors for all-cause mortality by multivariate analysis, GFR at the time of device implant was an independent predictor of mortality, even when adjusted for age, gender, arterial hypertension and diabetes (HR 1.12; 95% CI 1.04-1.16, p&lt;0.001). The best GFR cut-off value to predict mortality with a 69% sensitivity and 65% specificity was 75ml/min/1.73m</span></span><sup><span style="font-size:7pt"><span style="color:black">2</span></span></sup><span style="font-size:11pt"><span style="color:black">(AUC 0.70). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">The risk of death significantly increases along GFR&lt;90ml/min/1.73m<sup>2</sup>, with a 2.7-fold higher risk of death for stage 3a (HR 2.7 95% CI 1.15-6.52, p= 0.02), 5.5 for stage 3b (HR 5.51 95% CI 2.45-12.4, p&lt;0.001), 9.5 for stage 4 (HR 9.54 95% CI 3.95-23.06, p&lt;0.001) and 14.7-fold higher risk of death for stage 5 (HR 14.74 95% CI 4.94-43.99, p&lt;0.001).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><u><span style="font-size:11pt"><span style="color:black">Conclusion</span></span></u><span style="font-size:11pt"><span style="color:black">: </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">In our cohort of HF patients who underwent CIED implant, glomerular filtration rate was an independent predictor for all-cause mortality, with the increased risk of death starting in stage 3a and reaching a dramatic 14.7- fold higher risk of death for stage 5 patients.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">CKD should not therefore postpone CIED implant and renal function should be optimized before implant to prevent increased mortality.</span></span></span></span></span></p>