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Long term clinical outcome and echocardiographic response of patients submitted to upgrade to cardiac resynchronization therapy
Session:
SESSÃO DE POSTERS 52 - INSUFICIÊNCIA CARDÍACA, RESSINCRONIZAÇÃO E IMAGEM
Speaker:
Marta Catarina Bernardo
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Cartazes
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>: The benefits of upgrading to cardiac resynchronization therapy from a prior implanted pacemaker or defibrillator device, in patients with heart failure and reduced ejection fraction (HFrEF), remain unclear, and the clinical outcomes are conflicting.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To evaluate the echocardiographic response and clinical outcomes of a subgroup of patients (pts) submitted to upgrade CRT in comparison with the ones submitted to de-novo procedure. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Single centre, retrospective analysis of pts who underwent CRT implantation or upgrade procedures between 2017-2024. Echocardiographic response was defined as ≥10% improvement in left ventricular ejection fraction (LVEF) or ≥15% reduction in left ventricular end-systolic volume. The primary endpoint was all-cause mortality/heart failure (HF) hospitalization, while the secondary endpoint was all-cause mortality. The mean follow-up (FUP) was 33,0 ±19,2 months.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>A total of 221 pts were included, 68% male, age 73 (IQR 66-78) years, mean LVEF 30 ±8%, 33% ischemic. Of these, 20% underwent an upgrade procedure. The upgrade group had a higher rate of permanent atrial fibrillation (27% vs 14%, p= 0,037) and tended to present with more severe HF symptoms (NYHA class III/IV: 51% vs 36%, p= 0,08). The upgrade group had a higher prevalence of moderate-to-severe functional mitral regurgitation (54% vs 39%, p= 0,096) and larger left atrial volumes (57 ±20 vs 48 ±19 ml/m2, p= 0,013). Also, secondary prevention indications to ICD implantation were more common in the upgrade group (31% vs 6%, p<0,005) as well as pre-implantation beta-blocker use (89% vs 70%, p= 0,012). Rates of infection (p=0,59) and lead dislodgement (p=0,80) were similar. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Echocardiographic response rates were comparable (78% vs. 63%, p=0,073), as were superresponse rates (64% vs. 49%, p = 0,092), with a tendency for higher response in the de novo CRT group. Both groups had similar NYHA class improvement (61% vs 61%, p = 0,96). During follow-up, the upgrade group had a higher rate of the primary endpoint (41% vs. 27%, log-rank p = 0,042) (Fig.1), driven by more HF hospitalization (30% vs. 14%, log-rank p = 0,011) and a trend toward higher mortality (30% vs. 23%, log-rank p = 0.06) (Fig.2). In multivariate analysis, after adjusting for potential confounders, the rates of the primary endpoint were comparable between the CRT upgrade and de novo groups (HR 1.56, 95% CI: 0.85–2.84, p = 0.15), as were all-cause mortality rates (HR 1.53, 95% CI: 0.70–3.30, p = 0.29).</span></span></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 cohort, patients undergoing CRT upgrade, despite having more comorbidities and advanced heart failure, showed a similar echocardiographic response and NYHA class improvement compared to those receiving de novo CRT. However, during FUP, this subgroup experienced worse clinical outcomes, which were attributed to differences between the two populations rather than the therapy itself.</span></span></p>
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