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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Echocardiographic but not clinical response to CRT is an independent predictor of a better survival free from arrhythmic events
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Dinis Mesquita
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Dinis Valbom Mesquita; Leonor Parreira; Ana Esteves; José Farinha; Rita Marinheiro; Pedro Amador; Artur Lopes; Marta Fonseca; Claudia Lopes; Duarte Chambel; Alexandra Gonçalves; Rui Caria
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Cardiac resynchronization therapy (CRT) is of proven benefit in heart failure patients, improving mortality and reducing hospital admissions. There is however uncertainty if the arrhythmic risk is reduced in responders. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: We aimed to assess if patients with a CRT implanted for primary prevention had less arrhythmic episodes if they responded to this therapy and if echocardiographic and clinical responses to CRT differ regarding the occurrence of ventricular arrhythmias. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: We prospectively enrolled patients that underwent CRT implant for primary prevention according to ESC guidelines. Patients were classified as responders if they fulfilled one of four criteria (echocardiographic or clinical) at six months after implant: a 5% absolute improvement in LV ejection fraction (LVEF), a 15% improvement in LVEF, a 15% decrease in LV end-diastolic volume or a decrease in NYHA class. During follow-up with device interrogation, arrhythmic ventricular events (AVE) were classified as appropriate ICD therapies or sustained ventricular tachycardia either occurring in ICD monitoring zones or undetected by the device due to a slower rate, but clinically documented. All patients were further classified according to type of pacing, biventricular or LV only. Demographic characteristics of patients were also assessed. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: We enrolled 73 patients, 58 (79.5%) male, median age of 72 (65-77) years. Median LVEF was 28 (22-35)% (p=0.95 between groups), ischemic etiology in 36 (46.6%, p=1.00). The two groups, with and without AVE, did not differ significantly regarding clinical, echocardiographic or electrocardiographic characteristics (table). CRT echocardiographic response criteria were met by 49 (67.1%) of patients and clinical criteria by 53 (72.6%) patients. AVE<em> o</em>ccurred in 15 (20.5%) patients. In univariate regression analysis, echocardiographic response was associated with reduced AVE (OR 0,14; p=0,005). Clinical response to CRT was not associated with AVE (p=0.07). LV only pacing was associated with a higher probability of AVE (OR 5.1; p=0.038). In multivariate Cox regression for survival analysis, response to CRT was the only independent predictor of better survival free from AVE (HR 0.28;CI 95%, p=0.044) and LV only pacing was not associated with more episodes of ventricular arrhythmias (p=0.17). </span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusions</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: Echocardiographic, but not clinical response to CRT therapy, is the only independent predictor of a higher survival free from arrhythmic events. In spite controversies regarding the arrhythmogenic role of LV pacing, this was not associated with higher ventricular arrhythmic events. </span></span></p>
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