Preditores de resposta à terapêutica de ressincronização cardíaca: estudo cohort prospetivo

Translated title of the contribution: Predictors of response to cardiac resynchronization therapy: A prospective cohort study

Ana Abreu, Mário Oliveira, Pedro Silva Cunha, Helena Santa Clara, Vanessa Santos, Guilherme Portugal, Pedro Rio, Rui Soares, Luísa Moura Branco, Marta Alves, Ana Luísa Papoila, Rui Ferreira, Miguel Mota Carmo

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. Aims To identify baseline characteristics that might influence echocardiographic response to CRT. Methods and Results We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%). At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. Conclusion From a range of clinical and technical baseline characteristics, multivariate analysis only identified TAPSE as an independent predictor of CRT response, with TAPSE <15 mm associated with non-response. This study highlights the importance of right ventricular dysfunction in CRT response. ClinicalTrials.gov identifier: NCT02413151.

Original languagePortuguese
Pages (from-to)417-425
Number of pages9
JournalRevista Portuguesa de Cardiologia
Volume36
Issue number6
DOIs
Publication statusPublished - 1 Jun 2017

Keywords

  • Cardiac resynchronization therapy
  • Chronic heart failure
  • Predictors
  • Responder

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