PhD Scientific Days 2020

Clinical Medicine I. Posters

Long-term All-Cause Mortality of Patients After De Novo Vs. Upgrade Cardiac Resynchronization Therapy

Előadó neve

Dr. Schwertner, Walter Richard

Előadó munkahelye

The Heart and Vascular Center of Semmelweis University

Előadó telefonszáma

06 20 670 1702

Előadó e-mail címe

sch.walterichard@gmail.com

Az előadás címe

Long-term All-Cause Mortality of Patients After De Novo Vs. Upgrade Cardiac Resynchronization Therapy

Szerző(k) neve és munkahelye

Walter R. Schwertner1, Anett Behon2, Eperke Merkel3,Attila Kovács4, Endre Zima5, Valentina Kutyifa6, László Gellér7, Annamária Kosztin8, Béla Merkely9
1 Semmelweis University, Heart and Vascular Center, Budapest,
2 Semmelweis University, Heart and Vascular Center, Budapest,
3 Semmelweis University, Heart and Vascular Center, Budapest,
4 Semmelweis University, Heart and Vascular Center, Budapest,
5 Semmelweis University, Heart and Vascular Center, Budapest,
6 University of Rochester, Cardiology Division, Rochester, United States of America
7 Semmelweis University, Heart and Vascular Center, Budapest,
8 Semmelweis University, Heart and Vascular Center, Budapest,
9 Semmelweis University, Heart and Vascular Center, Budapest,

Szekció

Clinical Medicine I. Posters

Language of the presentation

English

Section, first choice

Clinical Medicine

Section, second choice

Health Sciences

Összefoglaló szövege

Introduction: However, patients with a conventional pacemaker (PM) or implantable cardioverter defibrillator (ICD) can develop heart failure due to the right ventricular pacing, recent guidelines do not provide a comprehensive recommendation for cardiac resynchronization therapy (CRT) upgrade.
Aims: To assess long-term clinical outcomes of patients who were upgraded to CRT from a PM or ICD and compared to those with De novo CRT implantation.
Method: Patients, who underwent CRT implantation based on the current guidelines at our clinic between 2000-2018 were registered. Primary endpoint was all-cause mortality, secondary endpoint was echocardiographic response 1 year after the implantation.
Results: Overall 2525 patients were included in our registry of which 1977 (78%) were De novo and 548 Upgrade (22%) patents. Regarding the baseline clinical characteristics of upgrade vs de novo groups, upgrade CRT patients were older, had higher percentage of prior myocardial infarction (MI), atrial fibrillation (AF), higher creatinine level, wider QRS and they were more frequently males. From 2525 patients 1085 (55%) de novo, and 346 (62%) upgrade patients reached the primary endpoint during the mean follow up time of 4 years. By univariate analysis all-cause mortality was 41% higher in the upgrade group compared to de novo group (HR 1.41; 95% CI 1.23-1.61; p<0.001). After adjusting for relevant clinical parameters multivariate Cox regression analysis showed similar outcome in the two groups (HR 1.22; 95% CI 0.92–1.41; p=0.37). When echocardiographic response was investigated, favourable improvement was found in the de novo CRT group 1 year after the procedure (∆LVEF De novo 9% vs Upgrade 5%; p=0.02; LVEF response de novo 63% vs Upgrade 54%; p=0.03). Regarding peri-procedural complications, pneumothorax occurred more frequently in de novo group, while lead disfunction and pocket infection occurred more frequently in after CRT upgrade.
Conclusion: CRT upgrade patients show higher risk of all-cause mortality compared to de novo CRT group, which is derived from co-morbidities. After adjusting for relevant clinical parameters, patients after CRT upgrade or de novo implantation showed comparable outcome. Furthermore, we found higher echocardiographic response rate in de novo CRT group. However, higher complication rate was associated with the CRT upgrade procedures.

Additional Information

Annamaria Kosztin
kosztin.annamaria@gmail.com

Bemutatás módja

Poszter

Kind

Szabad

Status

elfogadva

Accepted presentation method

poszter

Előadás fájl jóváhagyás

nem rendelkezett róla

Előadó

4607

Start

11:23

End

11:26

Authors (legacy)

Walter R. Schwertner1, Anett Behon2, Eperke Merkel3,Attila Kovács4, Endre Zima5, Valentina Kutyifa6, László Gellér7, Annamária Kosztin8, Béla Merkely9
1 Semmelweis University, Heart and Vascular Center, Budapest,
2 Semmelweis University, Heart and Vascular Center, Budapest,
3 Semmelweis University, Heart and Vascular Center, Budapest,
4 Semmelweis University, Heart and Vascular Center, Budapest,
5 Semmelweis University, Heart and Vascular Center, Budapest,
6 University of Rochester, Cardiology Division, Rochester, United States of America
7 Semmelweis University, Heart and Vascular Center, Budapest,
8 Semmelweis University, Heart and Vascular Center, Budapest,
9 Semmelweis University, Heart and Vascular Center, Budapest,