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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Myocardial activation velocity in the selection of CRT candidates
Session:
Posters - D. Heart Failure
Speaker:
Guilherme Portugal
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:
Guilherme Portugal; Inês Delgado; Mário Oliveira; Ana Abreu; Pedro Silva Cunha; André Viveiros Monteiro; Bruno Valente; Luísa Moura Branco; Rui Cruz Ferreira
Abstract
<p>Background: </p> <p>Cardiac ressynchronization (CRT) is effective in correcting electrical dyssynchrony as manifest by left bundle branch block (LBBB) and widened QRS duration. LBBB forces LV activation to be mediated by myocyte-to-myocyte transmission which has a slower conduction speed than ordinary conduction tissue. In addition, QRS duration is also related to left ventricular size and mass and may be significantly prolonged even in the absence of true LBBB in severely dilated hearts. We hypothesized that correcting QRS duration for LV size would allow better assessment of true LV activation delay and would be a more sensitive marker for patients benefitting from CRT.</p> <p> </p> <p>Aim: To understand whether a non-invasive index of myocardial activation velocity is related to outcome after CRT implantation</p> <p> </p> <p>Methods</p> <p>We performed a secondary analysis of the patients included in the BETTER-HF trial which was a prospective study of heart failure patients submitted to CRT. Patients were eligible if they presented indication for CRT implant according to current guidelines (LBBB+wQRS>130 ms or wQRS>150 ms for any QRS morphology).</p> <p>Path length (from start to end of LV activation) was calculated as <em>pi</em>*(end-diastolic LV intraventricular septum thickness + end diastolic LV diameter + end diastolic posterior wall thickness). Activation velocity was the calculated as (path length)/(QRS duration), resulting in the myocardial activation velocity (MAV) in meters/sec. MAV was compared with previously reported values for advanced HF patients with normal QRS duration.</p> <p>The primary outcome was a composite endpoint of death, admission for heart failure or appropriate shock >6 months after implant.</p> <p> </p> <p>Results</p> <p>54 patients had data on QRS duration and follow up events and were included in the final analysis. Mean age 76.8 +/- 11.2, male sex 59%, mean LVEF 24 ± 8%, 74% NYHA class ≥ III.</p> <p>Mean activation velocity was 2.04 +/- 0.36 m/sec and was significantly slower than in previously reported patients with normal QRS duration (mean 2.73 m/sec, p<0.001)</p> <p>Patients with LBBB presented a lower MAV than those with non-specific intraventricular delay (2.00+/-0.34 mm/ms vs 2.25+/-0.42 m/s, p=0.05).</p> <p>Logistic regression showed that MAV, but not QRS duration or baseline LVEF (p=ns), was associated with the primary outcome (Odds ratio 6.06, CI 1.07-34.3, p=0.042)</p> <p> </p> <p>Conclusions:</p> <p>In CRT candidates, myocardial activation velocity allowed more accurate identification of patients with true LV conduction delay; these patients had the greatest benefit from CRT at follow-up. This index may improve patient selection as compared with QRS duration measurement.</p>
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