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Response and long-term outcomes with resynchronization therapy: does heart failure etiology matter?
Session:
Posters (Sessão 4 - Écran 4) - Insuficiência Cardíaca 4 - Vários 2
Speaker:
Mariana Silva Brandão
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana s. Brandão; João Gonçalves Almeida; Paulo Fonseca; Elisabeth Santos; Filipa Rosas; José Nogueira 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 across all etiologies of heart failure (HF). Reverse left ventricular (LV) remodelling has been reported to occur more often in non-ischemic patients (pts).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong>: To compare response and outcomes after CRT in non-ischemic (NIHF) and ischemic (IHF) HF pts. </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). Major adverse cardiac events (MACE) included HF hospitalization or all-cause mortality (ACM). Clinical response was defined as New York Heart Association (NYHA) class improvement without MACE in the 1<sup>st</sup> year of follow-up (FU). Echocardiographic (echo) response implied left ventricle end-systolic volume reduction of >15% at 1-year. LV ejection fraction [LVEF] ≥50% during 1<sup>st</sup> year of FU defined superresponse. Survival analysis with Kaplan-Meier method and Log-rank test was performed to compare outcomes. Multivariate analysis was performed to assess if HF etiology predicted response to CRT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>295 pts (mean age 67±11 years, 91.5% left bundle branch block, baseline QRS 171±22 ms) were included. Pts in NIHF group (n=208, 72.5%) were more often female (35.6% <em>vs </em>15.6%, p<.001), tended to be younger (67 <em>vs </em>70 years, p=.05), had more valve disease (36.7% <em>vs </em>23.6%, p=.037) and kidney disease (32.9% <em>vs </em>18.5%, p=.015). In NIHF pts, right ventricular dysfunction (tricuspid annular plane systolic excursion <17 mm) was less common (25.6% <em>vs </em>47.1%, p=.039). Addition of defibrillator was identical (53.8% <em>vs </em>55.7%, p=.882).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">NYHA class improvement (79.4% <em>vs </em>78.4%, p=.987) and echo response (71.2% <em>vs </em>74.4%, p=.860) were similar. NIHF pts were more often superresponders (25.7% <em>vs </em>9.5%, p=.006), with greater improvement in LVEF (Δ 11.6% <em>vs </em>7.6%, p<.001). Clinical response was more frequent in NIHF pts (66.3% <em>vs </em>50.6%, p=.023). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">After multivariate analysis, HF etiology was not predictive of clinical (p=.960) or echo response (p=.075). During a mean FU of 3.8 years, occurrence of MACE (<em>Log rank</em> test, p<.001) and ACM (<em>Log rank</em> test, p<.001) were lower in NIHF </span><span style="font-size:10.0pt"><span style="color:black">[Figure]</span></span><span style="color:black">. Ventricular arrythmias (6.4% <em>vs </em>7.5%, p=.993) or appropriate defibrillator therapies (5.3% vs 7.5%, p=.743) did not differ.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusions: </span></strong><span style="color:black">In this cohort, consisting mostly of pts with LBBB and QRS </span><span style="color:black">≥</span><span style="color:black">150 ms, HF etiology did not predict clinical or echo response to CRT. Still, NIHF pts showed a greater extent of LV remodelling. Lower MACE and ACM rates were also observed in non-ischemic pts. </span></span></span></p>
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