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Heart failure clinical outcomes after cardiac resynchronization with quadripolar versus bipolar left ventricular leads
Session:
Posters (Sessão 3 - Écran 1) - Resincronização cardíaca
Speaker:
Mariana Martinho
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:
Mariana Martinho; João Grade Santos; Bárbara Marques Ferreira; Diogo Santos Cunha; João Mirinha Luz; Nazar Ilchyshyn; Oliveira Baltazar; Khrystyna Budzak; João Simões; Alexandra Briosa; Daniel Sebaiti; Rita Miranda; Sofia Almeida; Luís Brandão; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Quadripolar (QP) left ventricular leads are currently standard practice in cardiac resynchronization therapy (CRT) due to better implant and post operative lead performance when compared to bipolar (BP) electrodes. Although some evidence suggests that QP leads may increase response to therapy, data regarding clinical benefit is still missing.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> To compare QP and BP leads impact in clinical hard endpoints in pts with heart failure with reduced ejection fraction (HFrEF).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective observational single-center study that included 209 consecutive pts with EF<span style="font-family:Symbol">£</span>35% submitted to transvenous CRT implantation between 2012 and 2022. Logistic regression analysis was performed <span style="color:black">after proportional risk for outcomes was verified. Primary outcome was defined as total mortality and secondary outcome a composite endpoint (MACE) of total mortality, heart failure-related mortality and hospital admission due to heart failure. </span>A propensity score matching was performed to obtain a well-balanced subset of individuals with the same clinical characteristics (age, sex, hypertension, diabetes, hypercholesterolemia, coronary artery disease, valvular disease, chronic kidney disease, HF etiology, pre-implantation EF, NT-proBNP and QRS duration), resulting in 175 pts. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Among the study participants, mean age was 71±10y and 71.0% were males. QP leads were <span style="color:black">implanted in 67.3% (n=123) and there was no association with increased rates of implantation success (92.7% vs 90.6%, p=0.713). After a mean FUP of 53±26months, QP leads were not associated with total mortality (30.9% vs 36.7%, p=0.503) or MACE (33.9% vs 48.1%, p=0.091). A sub-analysis of MACE parameters showed a relative risk reduction of 54% in HF hospitalizations for QP leads (16.4% vs 30.0%, OR 0.46</span><span style="font-family:Symbol"><span style="color:black">[</span></span><span style="color:black">0.22-0.95</span><span style="font-family:Symbol"><span style="color:black">]</span></span><span style="color:black">, p=0.036). </span>HF-related death was similar in both groups. After a subgroup analysis comparing HF etiology, the benefit of QP electrodes in hospital admissions was only seen in non-ischemic HF pts (12.6% vs 34.2%, OR 0.28<span style="font-family:Symbol">[</span>0.11-0.790<span style="font-family:Symbol">]</span>, p=0.007). For ischemic pts, lead choice did not influence hospitalization (29.0% vs 23.8%, p=0.758), but QP electrodes showed a tendency to increase mean time until hospitalization (18±16months vs 42±22months, p=0.094). These results were consistent after a propensity score matching (figure 1). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> Although QP leads did not impact overall or HF-related mortality, it showed a significant impact in the reduction of HF hospitalizations, particularly in non-ischemic pts. This may not only lead to disease burden reduction and quality of life improvement in a relatively young population but also have an important economic impact related to HF. </span></span></p>
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