SPC365

Heart failure etiology and ARNI+SGLT2i initiation may influence ICD implantation timing

Session: Sessão de Posters 37 - Insuficiência cardíaca - Terapêutica farmacológica
Speaker: Jéni Quintal

Congress: CPC 2024
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.6 Chronic Heart Failure - Clinical
Session Type: Cartazes
FP Number: ---
Authors: Jéni Quintal; Sara Gonçalves; Tatiana Duarte; Pedro Carreira; Hugo Viegas; Margarida Madeira; Leonor Parreira; Dinis Valbom Mesquita; Rita Marinheiro; Rui Antunes Coelho; Ermelinda Pedroso; Filipe Seixo
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Background:&nbsp;</span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Implantable cardioverter-defibrillator (ICD) is recommended in patients (pts) with symptomatic Heart Failure (HF) and a left ventricle ejection fraction (LVEF) </span></span></span><em><span style="font-size:9.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif"><span style="color:#1d1d1d">&le;</span></span></span></em><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">35% despite </span></span></span><em><span style="font-size:9.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif"><span style="color:#1d1d1d">&ge;</span></span></span></em><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">3 months of optimal medical therapy (OMT) to reduce the risk of sudden death and all-cause mortality. However, the optimal timing of ICD implantation remains unclear and LVEF often recovers beyond 3 months of OMT. The impact of new neurohormonal therapies (NNHT) - ARNI/SGLT2i - is also unclear.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Purpose</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">To evaluate long term LVEF recovery in pts with implanted ICD after 3 months of OMT, LVEF predictors of recovery and the impact of NNHT.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Methods</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">We performed a retrospective single-center cohort study. Patients with symptomatic HF with LVEF </span></span></span><em><span style="font-size:9.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif"><span style="color:#1d1d1d">&le;</span></span></span></em><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">35% despite 3 months of OMT who underwent ICD implantation for primary prevention between 1 January 2013 and 30 June 2023 were included. Basal characteristics were determined. The population was divided in 2 groups: pts with recovered LVEF (gA) and pts without LVEF recovery (gB). The groups were compared regarding etiology, therapy and adverse events (arrhythmias, HF hospital readmission and all-cause mortality).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Results</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">This cohort included 114 pts with a mean age of 62 (</span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">&plusmn;</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d"> 9) years and an 83% male predominance. There was a high prevalence of cardiovascular risk factors as depicted in Table 1. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">After a median follow-up (FUP) time of 44 (1-127) months, 16 (14.4%) pts recovered, 52.6% improved and 9.6% deteriorated LVEF. When comparing the groups, a significant difference in HF etiology was verified, with DNICMP being more common (56.3% vs. 15.8%, p=0.014) and ischemic ICMP less common (43.8 vs. 77.9%, p=0.038) in gA. Median time until LVEF recovery was 27 (2-135) months. Notably, 56.3% of pts only recovered LVEF after ARNI and SGLT2i initiation (56.3%, p=0.001) within a median time of 19 (4-35) months. DNICMP </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;">[Exp (beta) 95% CI: 2.05 [2.36 &ndash; 25.53, p=0.001], </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">ICMP </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;">[Exp (beta) 95% CI: -1.69 [0.06 &ndash; 0.59, p=0.004] and concomitant therapy with ARNI and SGLT2i [Exp (beta) 95% CI: 1.52 [1.11 &ndash; 18.88, p=0.035] were independent predictors of LVEF recovery in multivariate analysis.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Only 1 pt in gA required ICD therapy, 63 months after ICD implantation, making ventricular tachycardia or ventricular fibrillation with ATP or ICD shock significantly more common in gB (6.3 vs. 17.9%; p=0.001). Overall median time until ICD therapy was 43 months. Hospital readmission due to HF and all-cause mortality were more common in gB (6.3% vs. 22.1%, p=0.021; 0 vs. 25.3%, p=0.036).</span></span></span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Conclusion</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Our study suggests ICD implantation delay beyond the standard 3 months of OMT may be reasonable, particularly in pts with DNIMCD. ARNI/SGLT2-i initiation significantly contributed to LVEF recovery, hinting at a role in avoiding unnecessary ICD implantation in selected pts. This underscores the need for personalized timing based on HF etiology and NNHT impact for more effective therapeutic strategies.</span></span></span></span></span></p>