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Prognostic implications of CRT response categorization
Session:
Posters (Sessão 3 - Écran 1) - Resincronização cardíaca
Speaker:
Daniel Inácio Cazeiro
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Daniel Inácio Cazeiro; Joana Brito; Pedro Silvério António; Sara Couto Pereira; Pedro Alves da Silva; Beatriz Valente Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Inês Aguiar Ricardo; Ana Bernardes; Andreia Magalhães; Fausto J. Pinto; João de Sousa; Pedro Marques
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"><strong>Introduction</strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">: </span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">CRT therapy is a mainstay treatment in patients (pts) with symptomatic heart failure (HF) despite optimal medical therapy with intraventricular conduction delay, specially left bundle branch block. However individual response to resynchronization is not homogeneous, with different observed rates of reverse remodeling, which may be associated with adverse clinical events.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"><strong>Purpose</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">: To characterize the impact of CRT response on LV remodeling and clinical outcomes.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"><strong>Methods</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">: Single center, retrospective study including consecutive patients submitted to CRT implantation from 2015 </span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">to 2020, with echocardiogram data before and after the procedure</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#c55911">. </span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">Study population was classified according to the CRT remodeling response: non responders - LVEF worsening above 5%; non-progressors – with a LVEF variation of < 5%; responders – LVEF increasing >5%; and super-response define by LVEF increasing above the 4</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"><sup>th</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"> quartile (20%). Impact of different classes of response on clinical events defined as hospitalizations due to HF and all-cause mortality, was evaluated with survival analysis.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"><strong>Results</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">: Considering a total population of 653 pts, the effect of CRT remodeling was evaluated in 344 pts (mean age 69±10 years old, 57.4% female sex). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">Population distribution was the following: 42 (12.2%) non responder, 113 (29.4%) non progressors, 123 (32%) responders and 101 (26.3%) superresponders. Clinical outcomes varied significantly between groups (p=0.003), with a 2-year freedom from event rate of 70%, 75%, 86%, 90% respectively – figure1. Additionally, NTproBNP at follow-up was also significantly higher with lower CRT response rates (p<0.001).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">A tendency to lower adverse clinical events was observed comparing non-progressors to non-responders (p = 0.054).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">The presence of typical LBBB was significantly more frequent in responders (p = 0.018), which was associated with both a better echocardiographic response (p = 0.018) and improved clinical outcomes (p <0.001). Baseline lower LVEF were associated with an increased CRT response (p <0.001). </span></span></span></p> <p style="text-align:justify"><br /> <span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"><strong>Conclusion:</strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222">Good prognosis was observed after CRT implantation in all groups, which improved in accordance to CRT response. Interestingly CRT non-progressors present a better prognosis compared to non-responder, suggesting a stabilization of HF progression. These results enhance the limitation of a purely division in non-responder and responder. Echocardiographic stabilization is related to a better prognosis than the natural disease</span></span></span></p>
Slides
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