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Aligning human and machine – predictors of super-response to CRT
Session:
Sessão de Posters 30 - Terapia de Ressincronização Cardíaca
Speaker:
Joao Santos Fonseca
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:
Joao Santos Fonseca; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões Oliveira; Miguel Azaredo Raposo; Catarina Gregório; Ana Abrantes; Nelson Cunha; Andreia Magalhães; João de Sousa; Fausto J. Pinto; Pedro Marques
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Cardiac resynchronization therapy (CRT) is a key therapy in contemporary heart failure management. Among patients (pts) submitted to CRT implantation according to current ESC guidelines, there are different grades of response. It’s key to leverage patient selection in order to achive the best results and health gains. The concept of super-responder is still under debate since several studies suggest different values for Left Ventricular Ejection Fraction (LVEF) and endsystolic volume to define it, but it’s unquestionable that such profile is associated with a better prognosis.</span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> To determine predictors of CRT super-response.</span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Single center retrospective study of pts in whom a CRT was implanted. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients submitted to pacemaker upgrade and CRT implantation due to nodal disease were excluded. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Addittionally, only pts with a mean time of follow-up of 3 years were included.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Clinical, ECG, laboratorial and echocardiogram data was collected at time of implantation and during follow-up. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Super-response was defined as an increase in LVEF above the 4th quartil (18%). Cox regression was used to define predictors of super-response and to evaluate impact on clinical outcomes (hospitalizations and mortality).</span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 235 pts were included (mean age 68.4 ± 9.7years-old, 45% male). In our population, 27.7% (n=65) of the patients were considered super-responders.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The presence of super-response was a predictor of better clinical outcomes during follow-up (p = 0.009, HR 2.342 [95% CI 1.231-4.455]).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Additionally, super-responders had significantly lower NT-proBNP levels at follow-up.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Regarding baseline echocardiographic evaluation, super-responders presented with lower LVEF, higher TAPSE and smaller left atrium. Additionally, super-response was more prevalent in males, patients with baseline left bundle branch block (LBBB) pattern and patients with higher eGFR. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Description of atrial fibrillation (Afib) and ischemic etiology had no impact on CRT response.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">On multivariate analysis: typical LBBB, male gender (p = 0.030, HR 2.121 [1.075-4.184]), LBBB (p=0.031, HR 2.178 [1.075-4.412]) and LVEF (p=0.018, HR 0.947 [0.906-0.991]) were the only independent predictors of super-response.</span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Aligned with previous studies, LBBB was an independent predictor of super-response. Somehow surprisingly, previous lower LVEF and male gender were also independent predictors of super-response; but not history of Afib neither ischemic etiology were associated with a worse response.</span></span></p>
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