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CRT-P vs CRT-D in non-ischemic cardiomyopathy: still a matter of debate
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 11 – AVANÇOS NA GESTÃO DA INSUFICIÊNCIA CARDÍACA
Speaker:
Marta Catarina Bernardo
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Marta Catarina Bernardo; Isabel Martins Moreira; Luís Sousa Azevedo; Isabel Nóbrega Fernandes; José P. Guimarães; Sílvia Leão; Renato Margato; José Paulo Fontes; Pedro Mateus; Sofia Silva Carvalho; José Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Cardiac resynchronization therapy (CRT) is a treatment with proven evidence in patients with heart failure and desynchrony. However, adding a defibrillator in patients with non-ischemic cardiomyopathy (NICM) is still a matter of debate and there are no clear recommendations about it.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim:</strong> To compare a population of patients (pts) with NICM that received CRT-D with the ones that received CRT-P in terms of basal characteristics, implant complications and clinical evolution. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective study of consecutive pts with NICM and a left ventricular ejection fraction (LVEF) ≤35% submitted to CRT implantation in a single centre between 2017 to 2024. The primary outcome was all-cause death and the secondary outcome was cardiovascular (CV) death. Response to CRT was defined as ≥10% improvement in LVEF or ≥15% reduction in left ventricular end systolic volume.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Out of a total of 221 pts, we included 91 pts, 58,2% male, median age 73,0 (IQR 36-87) years. The rate of success of transvenous implantation was 96,7% and the remaining pts implanted epicardial lead. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pts who implanted CRT-D were significantly younger (67 (IQR 36-84) years vs 78 (IQR 51-87) years (p<0,001)). We found no significant differences between groups in terms of cardiovascular risk factors, rates of atrial fibrillation (37% vs 33%, p=0,75) or chronic kidney disease (p= 0,08). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Both groups had similar LVEF (26 ± 5% vs 27 ±5%, p= 0,31) as well as rates of left bundle branch block (65% vs 61%, p= 0,64). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The pro-BNP of the CRT-P group was significantly higher compared to CRT-D group (1760 (129- 8761) pg/ml vs 3546 (IQR 418-15115) pg/ml, p=0,004). There were no differences between the two groups in complications, namely hematoma (p= 0,46), infection (p= 0,38) or lead dislodgement (p=0,84).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During a median follow-up of 39 (IQR 17-61) months, 20 (22%) patients died (55% of CV causes), 10 (11,0%) had ventricular tachycardia/appropriate therapy and 88% presented echocardiographic response to CRT. There were no differences between the groups in all-cause death (18% vs 28%, p= 0,78) or CV death (14% vs 10%, p= 0,62).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In a multivariate analysis, after adjusting for age and pro-BNP, the implantation of a defibrillator didn't reduce all-cause mortality (HR: 1,23; 95% CI: 0,50-3,18, p=0,62) (Fig.1) or CV mortality (HR: 1,8; 95% CI: 0,53-6,21, p= 0,35) (Fig.2).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Conclusion: </strong>In our population of pts with NICM and a LVEF ≤35% and an indication to CRT, the addition of a defibrillator lead was not significantly associated with a reduction in all-cause mortality or cardiovascular mortality, suggesting the need to improve risk stratification to identify the best candidates for CRT-D implantation in this setting.</span></span></p>
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