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Long-term outcomes after resynchronization therapy: a decade of experience from a single-center
Session:
Comunicações Orais - Sessão 01 - Insuficiência Cardíaca: a clínica primeiro
Speaker:
Mariana Silva Brandão
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana S. Brandão; João Gonçalves Almeida; Paulo Fonseca; Elisabeth Santos; Filipa Rosas; 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>: Cardiac resynchronization therapy (CRT) improves outcomes of heart failure (HF) patients (pts). We aim to report long-term outcomes after CRT implantation in a Portuguese center.</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 pts submitted to CRT implantation (2007-2018). Major adverse cardiac events (MACE) included HF hospitalization or all-cause mortality (ACM). </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 were included: mean age 67±11 yrs; 70.5% male; 72.5% non-ischemic HF; 76.7% NYHA III-IV. Comorbidities were prevalent: 65.9% hypertension, 33.6% diabetes, 32.6% atrial fibrillation, 26.8% moderate to severe valvular disease, 22.1% chronic kidney disease. Use of guideline-directed therapy: renin-angiotensin system inhibitors 86.4%; β-blockers 83.6%; mineralocorticoid receptor antagonists 56.4%. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Baseline QRS morphology was mainly left bundle branch block (91.5%), mean QRS duration 171±22 ms. Mean baseline LVEF was 27±7%. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Successful implantation at 1<sup>st</sup> attempt was accomplished in 94.6%; an epicardial lead was placed in 9 (3.1%) pts. Concomitant atrioventricular junction ablation was performed in 10 (6.6%) pts. CRT-D was implanted in 54.6%, of whom 23.6% had a secondary prevention indication. 19% of pts underwent an upgrade from a previous device, mostly from a conventional pacemaker.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At 1-year follow-up (FU), 80.3% of patients presented with biventricular pacing ≥95%. QRS duration decreased significantly (169±21 <em>vs</em> 154±23 ms, p<.001). Sustained ventricular arrhythmias were observed in 18 (6.9%) pts; appropriate therapies were delivered in 16 (6.2%) pts. Echocardiographic response (left ventricle end-systolic volume reduction >15% at 1-year) was reached by 72.0% of pts. Superresponse (LVEF ≥50% at 1-year) was achieved by 59 (21.4%) pts. Clinical response (New York Heart Association class improvement without MACE in the 1<sup>st</sup> year of FU) rate was 62.0%; 51 (19.2%) pts had a HF hospitalization. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During a mean FU of 3.8±3.1 yrs, lead complications were rare (8.5%), and were more common with CRT-D (12.4% <em>vs </em>3.7%, p=.014). Device infection occurred in 8 (2.7%) pts; 6 underwent explantation. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">MACE occurred in 36.2% of pts; 73 (24.7%) pts died from any cause [Figure]. 78 (57.8%) pts survived >5 years since implantation (mean FU 8±2 yrs).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions</strong>: CRT resulted in clinical and echocardiographic improvement, with few complications. The reported response rate is in line with previous landmark studies. Optimized implementation of CRT may stabilize the trajectory of HF pts.</span></span></p>
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