SPC365

Optimal Timing of CRT Implantation in Heart Failure - A Comparative Analysis of LVEF Recovery and Device Implantation

Session: Comunicações Orais - Sessão 08 - Insuficiência cardíaca: da clínica aos dispositivos
Speaker: Catarina Gregório

Congress: CPC 2024
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Gregório; Diogo Ferreira; Daniel Cazeiro; Ana Beatriz Garcia; Fátima Salazar; Nuno Lousada; Joana Rigueira; Rafael Santos; Doroteia Silva; Fausto J. Pinto; Dulce Brito; João R. Agostinho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Introduction:&nbsp;</strong></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Guidelines recommend implanting a cardiac resynchronization device (CRT) in patients with Heart Failure and Reduced Ejection Fraction (HFrEF) with left ventricle ejection fraction (LVEF) &le;35% despite optimized medical therapy (OMT) for 3 months and left bundle branch block (LBBB) and QRS duration &ge;150ms (Class I) or QRS &ge;130ms (Class IIa) or another intraventricular conduction delay and QRS &ge;150ms (Class IIa).However, there is growing debate that CRT may be considered before the 3 months threshold overlooking the role of&nbsp;</span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">OMT.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Purpose:&nbsp;</strong></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">To compare the LVEF at one year and outcomes of two groups of patients: those with baseline LVEF &le;35% and potential Class I or IIa indication for CRT who experienced LVEF improvement to &gt;35% at the 3-month follow-up and those who maintained LVEF &le;35% and had a Class I or IIa indication for CRT and that actually underwent CRT implantation.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Methods:&nbsp;</strong></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Single-center, observational, retrospective study that included 2 groups of patients with the characteristics described above. T-test was used to compare mean LVEF at baseline and 3 months and 1 year after OMT. Kaplan-Meier survival analysis was conducted to study prognosis impact.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Results:&nbsp;</strong></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Out of a cohort comprising 154 HFrEF patients, 39 had a baseline LVEF &le;35% and a potential Class I or IIa indication for CRT implantation. Twenty-four percent were female with an average age of 64.3 &plusmn; 14.2 years.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">At three-months after OMT, 41.1% of these patients improved to a LVEF <span style="color:black">&gt;</span>35%. Mean baseline LVEF in this subgroup was 28.3% and significantly improved to a mean LVEF of 39.5%. At 1-year these patients had a mean LVEF of 38.6% under OMT.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">The remaining 58.9% of patients maintained a LVEF <span style="color:black">&le;</span>35%. These patients started with a mean baseline LVEF of 25.3% and achieved a mean LVEF of 31.7% at 3-months. All proceeded to CRT implantation. At 1-year this subgroup significantly increased LVEF to a mean of 43.4%.The subgroups had similar age, baseline eGFR, NYHA class and NT-proBNP. There was not a statistically significant difference in LVEF at 1-year after OMT between the two subgroups (p=NS). When comparing a composite outcome of all-cause death and HF-hospitalizations at two years follow-up, patients with CRT had similar results to the patients with OMT alone (p=NS).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Conclusion:&nbsp;</strong></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Patients with HFrEF with a baseline LVEF&le;35% and a potential Class I or IIa indication for CRT benefit from waiting 3 months of OMT before deciding to implant a CRT, sparing a device implantation. As demonstrated, a significant portion of patients improve LVEF after OMT and have similar LVEF and outcomes when compared to patients who actually underwent CRT implantation.</span></span></p>