Author + information
- Federica De Vecchi,
- Eleonora Prenna,
- Enrico Boggio,
- Miriam Gravellone,
- Andrea Magnani,
- Eraldo Occhetta and
- Paolo Marino
Background: The positive impact of cardiac resynchronization therapy (CRT) on left ventricular function in the short-term is well established, although the exact mechanism through which it modulates prognosis is still unclear. Recently ventricular-arterial coupling (VAC) has been shown to exert prognostic stratification in heart failure patients. Study purpose was to assess whether long-term CRT clinical effects can be predicted according to acute VAC changes induced by biventricular [CRT on], as compared with AAI-VVI right stimulation pacing mode [CRT off], quantified at time of implantation.
Methods: In 149 patients (age 75+9 years, ejection fraction 31±10%) acute changes in cardiac index (CI), ventricular elastance (Ees), arterial elastance (Ea) and Ees/Ea, as obtained increasing heart rate from 69+11 to 110+10 beats/minute while measuring triplane echocardiographic ventricular volumes and continuous noninvasive blood pressure, were related to death/heart failure-rehospitalization during subsequent 3 years.
Results: There was an acute CI increase with CRT on (+6±46%, interaction p<0.03 vs. CRT off) as well as Ees (+4+30%, interaction p=0.025). Ea insignificantly decreased (-6+54%, interaction p=NS) modulating a marked improvement in VAC (Ees/Ea +20+142%, interaction p=0.013). At Cox analysis, however, neither CRT-induced changes nor baseline values of CI, Ees or Ea were associated with long-term follow-up. Only Ees/Ea at CRT off (hazard ratio 0,102 [95% confidence Interval 0,0135-0,775], p = 0,027) predicted death/heart failure-rehospitalization. Results were unmodified if age, gender, disease aetiology, QRS duration and ventricular diastolic volume at baseline were considered as other covariates. Event-free survival curves, obtained dividing patients according to median value of Ees/Ea (<>0.47), were significantly different (30 vs. 11 events, p<0.007).
Conclusions: Acute VAC improvement in CRT patients is not associated with 3 years prognosis. Death/heart failure-rehospitalization, instead, can be predicted from Ees/Ea at CRT off. Thus VAC can be used, before device implantation, to select patients who will be better responders to CRT.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-292
- 2017 American College of Cardiology Foundation