SPC365

Response to cardiac resynchronization therapy: what about the non-responders?

Session: Posters - C. Arrhythmias and Device Therapy
Speaker: M. Inês Barradas

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: M. Inês Barradas; Fabiana Duarte; Luís Oliveira; Cátia Serena; António Fontes; André Monteiro; Carina Machado; Raquel Dourado; Emília Santos; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong>Background:</strong> &nbsp;Cardiac resynchronization therapy (CRT) response is strongly associated with clinical outcomes and long-term prognosis in Heart Failure (HF) patients. In CRT non-responder patients, studies on&nbsp;</span></span></span><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000">clinical outcomes are lacking. </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong>Purpose:</strong> We ought to compare CRT responders and non-responder defined by echocardiographic criteria and to access the impact of clinical criteria in the non-responder patients.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong>Methods:</strong> <span style="color:#222222"><span style="background-color:white">We retrospectively enrolled </span></span>83 consecutive HF patients with implantable CRT (mean age 70,7 <span style="font-family:Symbol">&plusmn;</span>10,8 years; males 66,3%; mean follow-up of 63,39 <span style="font-family:Symbol">&plusmn;</span> 94,97 months). Echocardiographic response was defined as an increase in left ventricular ejection fraction (LVEF) &ge; 15% and c<span style="color:#222222"><span style="background-color:white">linical response as improvement </span></span>in New York Heart Association functional class (NYHA) &ge; 1, both 6 months after CRT implantation. <span style="color:#222222"><span style="background-color:white">Patients were evaluated through echocardiographic and clinical parameters and divided into CRT echocardiographic non-responders (Group 1) and CRT echocardiographic responders (Group 2). </span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong>Results: &nbsp;</strong>Seventy (84,3%) patients had CRT-defibrillator (CRT-D) and 13 (15,7%) CRT-pacemaker&nbsp;(CRT-P). <span style="color:#222222"><span style="background-color:white">Medium LVEF was </span></span>30,38 <span style="font-family:Symbol">&plusmn;</span> 7,69<span style="color:#222222"><span style="background-color:white">%, 22 (26,5%) patients were in NYHA III-IV and in </span></span>36,1% the aetiology was ischemic. HF hospitalizations and related admissions to emergency department (ED) occurred in 19,28% and composite outcome of HF hospitalizations, HF related admissions to the ED and death by all causes in 31,2% of patients. In total 10 (12,0%) <span style="color:#222222"><span style="background-color:white">patients died, 2 (2,4%) from sudden cardiac death and 5 (6,0%) from non-sudden cardiovascular death</span></span>. &nbsp;<span style="color:#222222"><span style="background-color:white">There were 44 (53,0%) echocardiographic non-responders to CRT (group 1).&nbsp; </span></span>Dyslipidemia (p=0,033) and obstructive sleep apnea (p=0,044) were more prevalent in group 1. There was no difference in age, gender, previous LVEF and ischemic aetiology between groups.<span style="color:#222222"><span style="background-color:white"> CRT non-responders had more HF hospitalizations, HF related admissions to the ED and death by all causes (p=0,010) and absence of NYHA improvement</span></span> and w<span style="color:#222222"><span style="background-color:white">orst NYHA after CRT were also associated with the composite outcome </span></span>(<span style="color:#222222"><span style="background-color:white">hazard ratio </span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">[</span></span></span><span style="color:#222222"><span style="background-color:white">HR</span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">]</span></span></span><span style="color:#222222"><span style="background-color:white">: 3,23; confidence interval </span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">[</span></span></span><span style="color:#222222"><span style="background-color:white">CI</span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">]</span></span></span> 0,839-12,445; p=0,045<span style="color:#222222"><span style="background-color:white"> and p=0,013 respectively).</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong><span style="color:#222222"><span style="background-color:white">Conclusion:</span></span></strong><span style="color:#222222"><span style="background-color:white"> Although echocardiographic CRT non-responders had worse outcome, the achievement of positive clinical criteria response, may be associated with better prognosis.&nbsp; </span></span></span></span></span></p>