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Predictors of non-response to cardiac resynchronization therapy
Session:
Sessão de Posters 30 - Terapia de Ressincronização Cardíaca
Speaker:
Luísa Pinheiro
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:
Luísa Pinheiro; Mariana Tinoco; Margarida Castro; Tamara Pereira; Sílvia Ribeiro; Víctor Sanfins; Olga Azevedo; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">INTRODUCTION:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> Cardiac resynchronization therapy (CRT) is an effective treatment for selected HF patients, but around 30% do not respond favorably. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">PURPOSE:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> To determinate the predictors of non-response to CRT.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">METHODS:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> Single-center retrospective study including HF patients submitted to CRT-D according to guidelines indications between 2013 and 2022. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and 6-12 months after CRT implantation. CRT response was defined as an increase in left ventricular ejection fraction (LVEF)≥10% or a reduction of LV end-diastolic volume (LVEDV)>15% at 6-12 months. Right ventricular systolic dysfunction (RVSD) was defined as S’ velocity <9.5 cm/s. The CRT responders were compared to the non-responders regarding the above parameters and regression analysis was performed to identify predictors of non-response to CRT.</span></span></span></span></span><br /> <span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">RESULTS:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> Out of a total of 149 patients (mean age 68±11 years; 69% males), 92 patients (62%) were considered responders after 6-12 months of CRT implantation. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">CRT non-responders were more frequently men (81% vs 61%, p=0.011) and had a higher frequency of CKD (54% vs 24%, p<0.001). In both groups, the most common HF etiology was non-ischemic and LBBB was the predominant QRS morphology (p=</span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">0.820, </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">p=0.799). </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">The incidence of AF during the first year of follow-up and % of biventricular pacing were also comparable (p=0.799, p=0.824). </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Regarding echocardiographic parameters, the non-responder group had a significantly higher Left Atrial Volume Index (51.4±25.5ml/m<sup>2</sup> vs 43.7±16.6, p=0.047) and a higher frequency of RVSD (51% vs 20%, p<0.001) and severe functional mitral regurgitation (FMR) (19% vs 5%, p=0.031). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">On multivariate analysis, male gender (OR=2.66, 95% CI: </span><span style="color:black">1.06-6.68</span><span style="color:black">; <em>p</em>=0.037), CKD (OR=3.47, 95% CI: </span><span style="color:black">1.60-7.54</span><span style="color:black">, p= 0.002), RVSD (OR=3.96, 95% CI:</span><span style="color:black"> 1.78-8.83</span><span style="color:black">,<em> p</em><0.001) and severe FMR (OR=3.63, 95% CI </span><span style="color:black">1.04-12.65, p=0.043</span><span style="color:black">) were identified as independent predictors of non-response to CRT. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">CONCLUSION:</span></strong> <span style="color:black">Non-response to CRT in our centre (38%) aligns with the literature. M</span><span style="color:black">ale gender, CKD, RVSD and severe FMR were identified as independent predictors of non-response. </span><span style="color:black">M</span><span style="color:black">ale gender is associated with worse CRT response, which is likely explained by the higher prevalence of ischemic heart disease, hindering effective LV stimulation due to myocardial scar tissue. </span><span style="color:black">RVSD and severe FMR are consistently linked to worsened LV remodeling</span><span style="color:black">. </span><span style="color:black">These findings highlight the importance of a comprehensive patient selection before CRT implantation.</span></span></span></p>
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