SPC365

Improvement of functional mitral regurgitation following cardiac resynchronization therapy: predictors and clinical outcomes

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

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">INTRODUCTION: </span></strong>Cardiac Resynchronization Therapy (CRT) is an established treatment for heart failure (HF). Functional Mitral Regurgitation (FMR) is common in patients with HF and CRT has been shown to lead to an improvement in FMR.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">PURPOSE: </span></strong><span style="color:black">Identify the predictors of<strong> </strong>FMR improvement with CRT and its impact on clinical outcomes.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">METHODS: </span></span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Retrospective, single-center study of patients undergoing CRT implantation between 2013 and 2022, </span></span><span style="color:black">with moderate or severe FMR. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and follow-up. </span>FMR was assessed qualitatively and graded on a scale of mild to severe. <span style="color:black">FMR improvement was defined as an improvement of &ge; 1 grade in MR class. <span style="font-family:&quot;Calibri&quot;,sans-serif">Response to CRT was defined as an increase in left ventricular ejection fraction (LVEF) &gt;10%. </span></span>The composite outcome of HF hospitalization and mortality from any cause was used to determine the prognosis.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">RESULTS: </span></strong><span style="color:black">A total of 42 patients were included in the study (mean age 72&plusmn;9.5 years; 60% male). Median follow-up was 58 [IQR 31-92] months. </span>Improvement of FMR after CRT <span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">implantation</span></span> was observed in 69% of the patients.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The group of <span style="color:black">FMR improvement</span> had a lower prevalence of atrial fibrillation (AF) (31% vs 69%, p=0.021). The reduction of QRS duration and the percentage of <span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">responders</span></span> were significantly higher (p&lt;0.001, <span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">15% vs 52%, p=0.027, respectively). </span></span><span style="color:black">There was a trend towards a higher percentage of FMR improvement in the epicardial (EPI) than in the transvenous (TV) lead <span style="font-family:&quot;Calibri&quot;,sans-serif">(68% vs 85%, p=0.144)</span>.</span> </span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Using multivariate analysis</span>, the absence of AF was an independent predictor of<span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> FMR improvement </span></span>(<span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">HR</span></span>: 0.064, 95% CI: 0.006 &ndash; 0.693<span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">, p=0.024)</span></span>, no other clinical, <span style="color:black">electrocardiographic and echocardiographic parameters were predictors <span style="font-family:&quot;Calibri&quot;,sans-serif">improvement in regurgitation</span>. </span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Survival-rate free of composite outcome was significantly higher in FMR improved patients when compared to non-improvers (HR</span></span>: 6.09, 95% CI: 2.14 &ndash; 17.31<span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">, p&lt;0.001), independent of CRT response.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION: </strong>Notably, our rate of FMR improvement slightly exceeded previous reports. AF was the only independent predictor of valvular regurgitation reduction. The role of CRT in patients with significant FMR is another crucial prognosis modifier. </span></span></p>