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Impact of right ventricular dysfunction improvement in heart failure patients treated with cardiac resynchronization therapy
Session:
SESSÃO DE POSTERS 52 - INSUFICIÊNCIA CARDÍACA, RESSINCRONIZAÇÃO E IMAGEM
Speaker:
Isabel Moreira
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Isabel Martins Moreira; Marta Catarina Bernardo; Luís Sousa Azevedo; Isabel Nóbrega Fernandes; José P. Guimarães; Sílvia Leão; Renato Margato; José Paulo Fontes; Inês Silveira; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction:</strong> Cardiac resynchronization therapy (CRT) is an established treatment in heart failure (HF). However, the effect of CRT on the right ventricle (RV) function and potential reverse remodelling have not been well described.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose: </strong>This study aimed to evaluate the impact of RV dysfunction and CRT-induced changes in RV function on clinical outcomes in HF patients (pts) treated with CRT.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Methods: </strong>Single-center retrospective study of consecutive pts submitted to CRT implantation (2017-2024). Echocardiographic parameters were evaluated at baseline and 6-12 months post-CRT. RV systolic dysfunction (RVSD) was defined as S’ velocity <9.5 cm/s or tricuspid annular plane systolic excursion (TAPSE) <17 mm. CRT response was defined as an increase of left ventricular ejection fraction (LVEF)≥10% or left ventricle end-systolic volume reduction (LVESV) ≥15%, and superresponse as LVEF≥50% at follow-up. Major adverse cardiac events (MACE) included HF hospitalization or cardiovascular mortality. Survival analysis with Kaplan-Meier method and <em>Log-rank </em>test was performed.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results: </strong>A total of 206 pts (median age 74 [IQR 66-79] years, 68,4% male, 67,5% non-ischemic cardiomyopathy) were included, 74 (35.9%) of whom had RVSD at baseline. Pts with RVSD were younger (70,5 vs 74.0 years, p=0.049), had higher alcohol consumption (42.5% vs 24.3%, p=0.01), higher prevalence of atrial fibrillation (45.9% vs 31.3%, p=0.042) and valvular prothesis (23.0% vs 3.7%, p<0.001). They also had lower baseline LVEF (28.3% vs 31.2%, p=0.006) and were less likely to present left bundle branch block (44.6% vs 64.3%, p=0.008). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">RV function improved in 36.5% pts after CRT. <span style="color:black">Favorable RV response </span><span style="color:black">was more common in pts with significant</span> <span style="color:black">baseline electromechanical intra-ventricular dyssynchrony </span>(48.0% vs 19.4%, p=0.023). Pts with improved RV <span style="color:black">function </span>exhibited better CRT response (83.3% vs 51.6%, p=0.014), a higher rate of superresponders (30.8% vs 9.4%, p=0.042), greater NYHA class improvement <span style="color:black">(</span>84.6% vs 59.4%, p=0.036), and lower all-cause mortality (18.5% vs 42.4%, p=0,048). No differences were observed in HF medical therapy between groups.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Over a mean follow-up of 35±24 months, patients with persistent RVSD had a higher occurrence of MACE events (38.8% vs 11.9%, <em>log-rank</em> p=0.003).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion: </strong><span style="color:black">In this cohort, CRT was associated with RV function improvement in </span><span style="color:black">approximately one-third of HF patients with RVSD</span><span style="color:black">, </span>which correlated with LV reverse remodelling and improved prognosis. Persistent RV dysfunction post-CRT was associated with higher occurrence of MACE events.</span></span></p>
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