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Response to cardiac resynchronization therapy in cancer patients with heart failure
Session:
Posters (Sessão 1 - Écran 2) - Cardio-oncologia
Speaker:
Catarina Gregório
Congress:
CPC 2023
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Catarina Gregório; Beatriz Valente Silva; Andreia Magalhães; Miguel Nobre Menezes; Paula Costa; Pedro Alves da Silva; Joana Brito; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Ana Abrantes; Miguel Azaredo Raposo; Pedro Marques; João de Sousa; Fausto J. Pinto; Manuela Fiuza
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Introduction: </strong>Heart failure (HF) is associated with poor clinical outcomes in cancer patients (pts). Although cardiac resynchronization therapy (CRT) is an important tool to improve prognosis, CRT has been historically underutilized in cancer pts.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Methods: </strong>Retrospective single-center review of pts who underwent CRT implantation from 2011 to 2022 with history of cancer. The main purpose of this study was to determine outcomes of CRT implantation in pts with cancer.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Results</strong>: A total of 44 pts with history of cancer underwent CRT implantation (61% male, mean age 72 years), with a mean follow-up of 29 ± 23 months. The most prevalent comorbidities were hypertension (91%), dyslipidemia (60%), chronic kidney disease (59%) and diabetes (45%). The most frequent sites of primary tumor were breast (27%), prostate (25%), colorectal (16%) and non-Hodgkin lymphoma (16%). Three patients had metastatic disease. The most prevalent HF aetiologies were ischemic (32%) and secondary to chemotherapy (32%), followed by non-chemotherapy related dilated cardiomyopathy (30%) and valvular heart disease (7%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Left ventricular ejection fraction (LVEF) increased from 29 ± 5% to 37 ± 12% (p=0.002) after CRT [23 (52%) had an increase of at least 5% in LVEF and 16 pts (36%) had an increase of at least 10% in LVEF from pre- to post-CRT implant]. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">There was a significant reduction in left ventricular end-systolic (LVESV) and end-diastolic volume post-CRT implant (p=0.002 and p=0.007, respectively). According to LVESV reduction, 11 pts (25%) were super responders (reduction of LVESV≥30%), 4 pts (9%) responders (reduction of LVESV 15-29%), 3 pts (5%) non-responders (reduction of LVESV≤14%) and 3 pts (7%) were considered progressor due to worsening of LVESV during follow-up. NYHA class function improved (p<0.001) and NTproBNP had a significant reduction (p=0.046) after CRT implantation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">We found no difference in age, gender, comorbidities, HF prognosis-modifying pharmacological therapy and CRT response between pts with ischemic and non-ischemic HF.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Mortality rate during follow-up was 36% (n=16), mostly due to cardiovascular disease (44%). None of the deaths were attributable to neoplastic disease. Four patients died within 12 months after CRT implantation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Conclusion</strong>: CRT improves LVEF, reverses left ventricular remodeling and improves symptoms in pts with cancer and HF, with a non-inferior response rate to that described in the general population. </span></span></p>
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