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Refining CRT Candidate Selection: The Power of True LBBB on Left Ventricular Reverse Remodeling
Session:
Sessão de Posters 53 - Otimização de CRT em 2026
Speaker:
Joana Simões de Azevedo Massa Pereira
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Joana Massa Pereira; Sofia Andraz; Lucas Hamann; Joana Guerreiro Pereira; Daniela Carvalho; Raquel Fernandes; João Sousa Bispo; Dina Bento; Pedro Azevedo; Rui Candeias; Hugo Alex Costa; Jorge Mimoso
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Introduction: </span></strong><span style="font-size:10.0pt">One of the most potent predictors of cardiac resynchronization therapy (CRT) benefit is the presence of left bundle branch block (LBBB). However, variations in LBBB morphology - true complete LBBB (tcLBBB) or LBBB like pattern (lpLBBB)) - are often seen in the clinical setting and their impact on left ventricular (LV) reverse remodeling remains incompletely understood.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Objective: </span></strong><span style="font-size:10.0pt">To evaluate the association between LBBB morphology and the degree of reverse LV remodeling in patients undergoing CRT. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Methods: </span></strong><span style="font-size:10.0pt">A retrospective analysis between 2020 and 2023 included 95 patients who underwent CRT implantation. Data collected included demographics, cardiovascular risk factors, echocardiographic and electrocardiographic parameters. Patients were divided according to LBBB morphology (lpLBBB vs tcLBBB). LBBB European Society of Cardiology criteria was used to identify tcLBBB morphology. Reverse remodeling was defined as a reduction in left ventricular end-diastolic volume (LVEDV). Predictors of reverse remodeling were identified using multivariate linear regression.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Results: </span></strong><span style="font-size:10.0pt">The final cohort included 88 patients, of whom 51 (58%) with lpLBBB and 37 (42%) with tcLBBB. The mean age was 69.5±10.4 years, with 77.3% being male. Mean baseline LVEDV post-CRT implantation was 168±93ml, without differences between groups (169±58 vs 159±85, p=0.071). Mean biventricular pacing was 95.9% with no differences between groups. QRS reduction ≥ 26ms (51.4%, p<0.001), LBBB > 150ms (98.8%, p=0.001), use of mineralocorticoids receptor antagonists drugs (81.1%, p=0.047) and QRS variation (28.2±20.5, p<0.001) were more frequent among tcLBBB. The degree of remodeling measured by LVEDV were significantly more relevant in tcLBBB group (LVEDV 214ml --> 159ml, p=0.006), as well as the degree of LVEF improvement (29.7% --> 44.2%, p=0.001). CRT super-response occurred in 23 (39.7%) patients, significantly more frequent in tcLBBB (62.5%, p=0.003). tcLBBB showed to be a strong predictor of reverse remodeling increasing the probability by ~50 times (B =53.4, t = 2.1, p=0.043). Other predictors of reverse remodeling were younger age (p=0.020) and higher BiV (p=0.018).</span></span></span></p> <p><strong><span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">Conclusions: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">In this cohort, tcLBBB morphology prior to CRT implantation was a strong predictor of LV reverse remodeling, increasing the probability of LVEDV reduction by nearly 50 times, after implantation. These findings suggest that tcLBBB may be a necessary substrate for substantial remodeling and potential disease remission following CRT. Nonetheless, other variables should be considered in the heart failure puzzle and CRT response. </span></span></p>
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