SPC365

From reduced to normal left ventricular ejection fraction: what makes a super-responder to CRT?

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="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">INTRODUCTION: </span></span></strong><span style="color:black">Cardiac resynchronization therapy (CRT) is an effective treatment for selected <span style="font-family:&quot;Calibri&quot;,sans-serif">heart failure (HF)</span> patients.<span style="font-family:&quot;Calibri&quot;,sans-serif"> The response, however, may vary widely. Some patients exhibit above-expected improvement, linked to a better prognosis, known as super-responders (SRs).</span></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">PURPOSE: </span></span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">To identify predictors of CRT super-response.</span></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"> Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and follow-up. </span>A super-response to CRT was defined as the recovery of left ventricular (LV) ejection fraction (LVEF) to a value &ge;50%. The composite outcome was the occurrence of major adverse cardiac events (MACE), which were defined as HF or <span style="font-family:&quot;Calibri&quot;,sans-serif">cardiovascular mortality</span>. SRs were compared to non-SRs regarding the above parameters and regression analysis was performed to identify predictors of super-response to CRT.</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">RESULTS:</span></strong> A total of 149 patients were included in the study (mean age 68&plusmn;11 years; 69% male), patients that are not followed in our center were excluded. Median follow-up was 4.7 [IQR 2.4-6.9] years. In this study, 28 (19%) were deemed as SRs.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">SRs were more frequently of women (63% vs 33%, p=0.031), a lower frequency of chronic kidney disease (11% vs 41%, p=0.031) and right ventricular systolic dysfunction (RVSD) at baseline (14% vs 33%, p=0.05). After CRT, effective biventricular pacing (BiV&ge;98%) and QRS duration &le;150ms were achieved on a higher percentage in the SRs group (88% vs 61%, p=0.043; 92% vs 81%, p=0.031, respectively).</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A higher frequency of super-response was observed in the epicardial (EPI) vs. the transvenous (TV) leads <span style="font-family:&quot;Calibri&quot;,sans-serif">(25% vs 15%, p=0.156)</span> and in the non-ischemic versus ischemic heart disease (22% vs 13%, p=0.140), although not achieving statistical significance.</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">On multivariate analysis, female gender</span> <span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">(</span></span>OR=9.70, 95% CI: 1.27-74.32; p=0.029) and BiV pacing &ge;98% (OR=59.10, 95% CI: 2.238-1560,66, p= 0.015) were independent predictors of super-response to CRT.</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">Survival-rate free of MACE was significantly higher on the SRs group than in the non-SRs group (HR</span>: 3.60, 95% CI: 1.11- 11.63<span style="font-family:&quot;Calibri&quot;,sans-serif">, p=0.010). </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">CONCLUSION: </span></span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">The frequency of SRs </span></span><span style="color:black">to CRT in our centre (19%) is in concordance with literature. </span><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Our study confirms that female gender and effective BiV pacing are independent predictors of super-response to CRT</span></span><span style="color:black"> and that a super-response to CRT is associated with a better prognosis.</span></span></span></p>