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Predictors of mortality after cardiac resynchronization: a new look at the ejection fraction

2013; Oxford University Press; Volume: 34; Issue: suppl 1 Linguagem: Inglês

10.1093/eurheartj/eht310.p5732

1522-9645

Hemilly Cirqueira Martins, F Soares, Nádia Moreira, Ana Rita Ferreira, Rui Baptista, Natália António, M Ventura, João Cristóvão, Pedro Monteiro, Mariano Pêgo,

Cardiac pacing and defibrillation studies

Introduction: Cardiac resynchronization reduces morbidity and mortality in patients with Heart Failure (HF). However, it remains controversial which are the best predictors of response, either before implantation or during follow-up. In this work we intend to evaluate the variation of Ventricular Ejection Fraction (LVEF) as a potential predictor of mortality. Population and methods: Prospective and longitudinal study with 79 consecutive patients who underwent cardiac resynchronization therapy since October 2009 and April 2012 in a single center. Echocardiographic evaluation was performed in all patients before and 6 months after device implantation. We calculated the difference in LVEF between these time points and using ROC curve it was determined the best cutoff. The resulting groups were studied with respect to demographics, functional class and etiology of HF. The primary endpoint was mortality from all causes. The median follow-up was 714 days. Results: The median age was 65±9.4 years and 63% were male. The etiology of HF was ischemic in 27% of patients, whereas 60.1% of patients were in NYHA class III. Mean LVEF was 24.5±7.1% before device implantation and 32.8±10.2 after, there was a mortality of 11.3% during follow-up. ROC curve (AUC 0.726) allowed to identify 20% of LVEF as the best predictor of survival (69% specificity and 77% sensitivity). The hazard ratio was 0.18 (95% CI 0.037-0.871, p = 0.03). Conclusion: After cardiac resynchronization there is only a significant reduction on mortality if LVEF improves by about 20% over a period of six months. This result reinforces the importance of global optimization of therapy in these populations.