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Superresponse to cardiac resynchronization therapy: clinical outcomes and predictors
Session:
Posters - D. Heart Failure
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:
Posters
FP Number:
---
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>Resynchronization therapy (CRT) reduces mortality in selected patients with heart failure with reduced ejection fraction (HFrEF). Patients that experience significant reverse remodelling and left ventricular (LV) ejection fraction (LVEF) improvement have been called “superresponders”. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>AIM:</strong> To describe a cohort of superresponders and identify predictors of superresponse 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 CRT implantation (2007-2018). Superresponse was defined as LVEF≥50% during the 1<sup>st</sup> year of follow-up (FU). Major adverse cardiac events (MACE) included heart failure hospitalization or all-cause mortality. Multivariate logistic regression was performed to identify predictors of superresponse. Survival analysis with Kaplan-Meier method and <em>Log-rank</em> test was performed to compare outcomes between superresponders and non-superresponders. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS:</strong> 295 CRT patients (70.5% male, mean age 67±11 years) were included. Fifty-nine (21.4%) patients were superresponders. Superresponders were more often female (42.4% <em>vs </em>25.8%, p=.021), tended to be older (69.6 <em>vs </em>66.7 years, p=.054) and had lower rates of coronary disease (17.2% <em>vs 3</em>2.9%, p=.032) , atrial fibrillation (20.3% <em>vs </em>38.0%, p=.018), valve disease (13.6% vs 30.0%, p=.018) and chronic kidney disease (6.9% <em>vs </em>26.0%, p=.003). Superresponders had higher rates of non-ischemic HF (88.1% <em>vs </em>69.1%, p=.006) and were more often implanted with CRT-P (69.5% <em>vs </em>37.8%, p<.001). HFrEF medication did not differ between groups. Superresponders had lower baseline LV end-systolic volumes (115.5 vs 166.2 ml, p<.001) and N-terminal pro B-type natriuretic peptide (NT-proBNP) values (1232.6 <em>vs </em>5252 pg/ml, p<.001). Baseline QRS duration did not differ (171.7 <em>vs </em>171.3 ms, p=.883). During a median FU of 3±5 years, there were no differences in terms of ventricular arrythmias (5.3% <em>vs </em>6.8%, p=.913) or appropriate defibrillator therapies (1.8% <em>vs </em>6.8%, p=.147) between groups. In addition to LVEF improvement (53.7% <em>vs </em>35.3%, p<.001), superresponders also showed higher tricuspid annular plane systolic excursion values (22.1 <em>vs </em>19.8 mm, p=.004) during FU. MACE occurred less frequently (<em>Log-rank</em> test, p=.003) and all-cause mortality (<em>Log-rank</em> test, p<0.001) was lower in superresponders. Multivariate analysis identified female gender (odds ratio [OR] 5.7, 95% confidence interval [CI] 1.03-31.73, p=.045), older age (OR 1.1, 95% CI 1.02-1.24, p=.017) and lower baseline NT-proBNP (OR 0.9, 95% CI 0.99-1.00, p=.011) as independent predictors of superresponse to CRT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION: </strong>In superresponders, in addition to a significant improvement in LVEF, we observed an improvement in right ventricular function. As expected, MACE and all-cause mortality were lower. Female gender, older age and lower baseline NT-proBNP predicted super-response to CRT. </span></span></p>
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