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Re-evaluation of response to CRT: long-term impact of echocardiographic non-progression
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Eric Monteiro
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:
Eric Alberto Monteiro; Marta Madeira; Natália António; Vera Marinho; James Milner; Pedro Sousa; Miguel Ventura; João Cristovão; Luís Elvas; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background and purpose:</span></strong><span style="font-family:"Arial",sans-serif"> As heart failure (HF) is a progressive disease, there has been a raising idea that considering the absence of echocardiographic improvement as non-response to cardiac resynchronization therapy (CRT) may not be appropriate. In fact, in some classical echocardiographic non-responders, CRT might have prevented HF deterioration. Our aim was to compare the composite outcome of death and re-admissions due to HF according to a new classification of CRT response: responders, non-progressors and progressors.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods</span></strong><span style="font-family:"Arial",sans-serif">: We included 144 consecutive patients with HF, left ventricle (LV) ejection fraction < 40% and QRS duration > 120mseg submitted to CRT implantation. Patients were divided into 3 groups according to the variation of LV end-systolic volume (LVESV) at 6-month: ≥15% reduction in LVESV - responders (R); 0–15% reduction in LVESV – non-progressors (NPr); increase in LVESV – progressors (Pr). A long-term follow-up (4.9 </span><span style="font-size:8.0pt"><span style="font-family:"Arial",sans-serif">± </span></span><span style="font-family:"Arial",sans-serif">2.9 years) was performed targeting mortality and re-admissions due to HF. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results</span></strong><span style="font-family:"Arial",sans-serif">: In our population, 78 patients (54.2%) were classified as R, 21 (14.5%) as NPr and 45 (31.3%) as Pr. Baseline comparison between groups is presented in table 1. Compared with R, N-Pr had ischemic aetiology more frequently. The prescription of digoxin was more common in Pr. The Kaplan-Meier curves (figure 1) demonstrate that the composite outcome of death and re-admission due to HF had a lower incidence in R, but was similar between N-Pr and Pr. After adjustment of possible confounders (ischemic aetiology and digoxin use), the type of response to CRT remained as the only predictor of outcomes (OR 0.61; CI 0.41-0.90). 144</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="font-family:"Arial",sans-serif">Conclusion</span></span></strong><span style="background-color:white"><span style="font-family:"Arial",sans-serif">: In our population, patients without progression of HF had a similarly negative prognosis to the ones that deteriorated. Hence, positive LV remodelling, and not only stabilization, seems to be necessary to improve long-term prognosis.</span></span></span></span></p>
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