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Cardiopulmonary exercise testing to assess the effect of cardiac resynchronisation therapy
Session:
SESSÃO DE POSTERS 48 - RESSINCRONIZAÇÃO CARDÍACA E CDI
Speaker:
André Paulo Ferreira
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:
André Paulo Ferreira; Ana Raquel Santos; Sofia Jacinto; Hélder Santos; Bruno Valente; Guilherme Portugal; Ana Lousinha; Pedro Silva Cunha; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p>Background: Cardiac resynchronization therapy (CRT) is a well-established intervention for a subgroup of patients with heart failure (HF), that often leads to reverse remodelling and symptomatic improvement. The cardiopulmonary exercise test (CPET) is a strong and validated exam to assess functional capacity that may be useful for evaluating the CRT benefits.<br /> <br /> Purpose: To investigate the utility of CPET in assessing the impact of CRT on the cardiopulmonary systems, and to ascertain if it can aid in identifying likely responders.<br /> <br /> Methods: A single-centre retrospective study of patients with HF and reduced left ventricle ejection fraction (LVEF) that underwent CPET and transthoracic echocardiogram before and after 6 months of CRT implantation. CRT responders were defined as those exhibiting an absolute >5% improvement in LVEF at 6 months of follow-up. Multiple CPET parameters were analysed in both responder and non-responder groups and multivariate logistic regression models were used.<br /> <br /> Results: A total of 24 patients were included in this study. Patient's mean age was 60.9±11.7 years, and 83.3% were male. At the baseline, 46.1% had ischemic heart disease and 53.9% dilated cardiomyopathy, 71.4% had left bundle branch block with a QRS > 130ms, the mean LVEF was 30.7±6.8% and the median New York Heart Association functional (NYHA) class was 2 (IQ 2-3). At 6 months follow-up after CRT implantation, 67.4% of patients showed a reverse remodelling response with an improvement greater than 5% in LVEF. In the responder group, the mean LVEF was 35.8±8.4% at 6 months, and the peak VO2 increased significantly 11.5±3.8 vs 12.7±3.5 ml/kg/min (p = 0.039), as well as the per cent predicted peak VO2 43.9±19.2% vs 51.6±19.1% (p = 0.034), while the minute ventilation/carbon dioxide production (VE/VCO2) slope decreased 43.0±9.4 vs 36.6±7.5 (p = 0.021). An increase of ≥1 in NYHA classes was registered in 65.4% of the total patients. After multivariate analysis, patients with a VO2 peak <50% of the predicted value were found to be more likely responders (p = 0.029). No other CPET parameters were predictive of CRT response or non-response.<br /> <br /> Conclusion: CPET appears to be a helpful tool in assessing the benefits obtained after CRT, possibly allowing a better prognostic and risk stratification, while the identification of the more probable responders remains a challenging task.</p>
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