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Impact of Right Ventricular Dimension and Function on Outcomes in Patients Undergoing Cardiac Resynchronization Therapy
Session:
Sessão de Posters 30 - Terapia de Ressincronização Cardíaca
Speaker:
Francisco Rodrigues Dos Santos
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Francisco Rodrigues Dos Santos; Vanda Devesa Neto; António Costa; Inês Pires; Gonçalo Ferreira; Mariana Duarte Almeida
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Calibri Light",sans-serif"><span style="color:#0f0f0f">Background: Adverse remodeling in the right ventricle (RV) involves progressive RV dilation and systolic dysfunction, serving as crucial prognostic indicators for patients undergoing cardiac resynchronization therapy (CRT). However, the combined prognostic value of assessing these parameters in a unified model remains unexplored.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Calibri Light",sans-serif">Purpose: This study aims to investigate the relationship between RV dimension and RV systolic function, assessed prior to CRT implantation, and their influence on overall outcomes.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Calibri Light",sans-serif"><span style="color:#0f0f0f">Methods: In a single-center retrospective study, all consecutive patients who underwent CRT implantation between 2012 and 2019 were included. Echocardiography at the time of device implantation analyzed RV dimension and longitudinal function. Patients were categorized into three groups: A – RV with normal dimension and function, B – RV with normal dimension and Tricuspid Annular Plane Systolic Excursion (TAPSE) < 17mm, and C – dilated RV and TAPSE < 17mm. A 24-month follow-up assessed the primary endpoint, a composite of all-cause mortality, detection of ventricular arrhythmias, and cardiac hospitalization. Group comparisons used Chi-square and Mann-Whitney U tests, while survival analysis utilized Cox regression and Kaplan-Meier curves. Multivariable analysis employed logistic regression.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Calibri Light",sans-serif"><span style="color:#0f0f0f">Results: The study included 102 patients (74.5% male, mean age 68 ± 10.46 years). NYHA class distribution was 46.1% - II, 51% - III, and 2.9% - IV. Ischemic cardiomyopathy was diagnosed in 32.4%, with 66.7% receiving CRT-D. The 24-month mortality was 8.8%, 2.94% experienced inappropriate shocks, and 27.5% were unresponsive to CRT. Group A comprised 71.6% of patients, Group B 11.8%, and Group C 9.8%. Multivariate logistic regression showed that RV dimension independently predicted the endpoint (OR 3.54; 95% CI 1.03-12.08; p=0.04), adjusted for ischemic etiology and LVEF at CRT implantation. RV systolic function did not independently predict the endpoint (OR 2.02; 95% CI 0.68-6.04; p=0.21). Cox regression analysis revealed that group C was an independent predictor of mortality when adjusted by LVEF and ischemic. When stratified by groups, the classification revealed a progressive decline in survival for those with normal RV dimension and function, normal RV dimension but declined function, and dilated RV with declined function (Kaplan-Meier </span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:#0f0f0f">χ</span></span><span style="font-family:"Calibri Light",sans-serif"><span style="color:#0f0f0f">²=3.51; p=0.04) - graph 1. </span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Calibri Light",sans-serif"><span style="color:#0f0f0f">Conclusion: Comprehensive prognostic assessments for CRT recipients should consider both right ventricular size and function. Incorporating both parameters enhances prognostic value in assessing adverse outcomes.</span></span></span></span></p>
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