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Mitral regurgitation in heart failure patients undergoing cardiac resynchronization therapy – does it affects clinical outcomes?
Session:
Sessão de Posters 30 - Terapia de Ressincronização Cardíaca
Speaker:
Fabiana Duarte
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:
Fabiana Silva Duarte; Inês Santos; Maria Inês Barradas; Luís Oliveira; Cátia Serena; André Monteiro; Carina Machado; Raquel Dourado; Emília Santos; Nuno Pelicano; Dinis Martins
Abstract
<p>Background: Cardiac resynchronization therapy (CRT) is a well-established treatment for specific heart failure (HF) patients´ groups, enhancing outcomes in both ischemic and non-ischemic HF cases. Mitral regurgitation (MR) is a common finding with uncertain reported impact on prognosis. </p> <p>Purpose: Investigate clinical outcomes in HF patient undergoing CRT based on MR severity assessed before and 1 year after device-based therapy, considering both ischemic and non-ischemic HF etiologies.</p> <p>Methods: Single-center retrospective study of CRT-implanted patients, stratified MR severity at baseline and post-CRT into significant (moderate and severe MR) or non-significant MR groups. Primary endpoint comprised major adverse cardiac events (MACE), involving HF hospitalization or all-cause mortality. Secondary endpoint included sustained ventricular arrhythmic events.</p> <p>Results: 117 HF patients (mean age 71.1±10.6 years, males 67.5%) were enrolled, 31.6% having ischemic HF and 23.9% falling into the baseline significant MR (SMR) group. Baseline characteristics revealed 40.2% with atrial fibrillation (AF), 23.9% with obstructive pulmonary disease (COPD) and 9% with peripheral artery disease (PAD). SMR patients showed more dyslipidemia (p=0.026) and lower left ventricular ejection fraction (median 25%vs32%, p=0.001).<br /> At 1-year follow-up, 11.1% had significant MR, mostly with the same degree (61.5%), and presented higher NYHA class (p=0.032). During follow-up, 15.4% reached the primary endpoint, while 8.5% reached the secondary endpoint. Ischemic etiology and baseline MR severity did not predict either endpoint in SMR and non-SMR groups (p=0.204, p=0.106 vs p=0.191, p=0.213).<br /> However, male gender (p=0.033), alcohol consumption (p=0.003), PAD (p=0.004) and COPD (p=0.005) independently predicted MACE endpoint at a multivariable analysis. For the secondary endpoint, PAD (p=0.020) and AF (p=0.001) were significant predictors. Notably, significant MR post-CRT was a strong independent predictor only for MACE outcome (HR 4.3 95% CI 2.1–6.1, p=0.014).</p> <p>Conclusions: Baseline significant MR did not show an association with clinical outcomes following CRT implantation. However, MR at follow-up was a strong determinant of increased mortality and HF hospitalizations, especially in more symptomatic patients, irrespective of HF etiology. Patients exhibiting persistent MR after CRT should also be evaluated for potential valvular interventions.</p>
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