Heart Failure Etiology in Patients Undergoing Cardiac Resynchronization Therapy: Is It Relevant?

Silvia Deaconu,Aura Vijiac,Sebastian Onciul,Alexandru Deaconu,Corneliu Iorgulescu,Ioana Petre,Amalia Petre,Gabriela Marascu,Radu Vătășescu ,Alina Scărlătescu ,Стефан Богдан ,Andra-Victoria Radu ,Maria Dorobanţu

doi:10.31689/rmm.2021.28.2.153

Abstract

Background: Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HfrEF). Etiology may influence the outcome of patients undergoing CRT. Objective: to evaluate whether etiology (ischemic vs non-ischemic) influences the response to CRT and overall outcome. Methods: Our study included HFrEF patients undergoing CRT between January 2017-November 2019. We assessed right ventricle (RV) and left ventricle (LV) function using transthoracic echocardiography at baseline and one year after CRT. The response to CRT was defined by a decrease of more than 15% of left ventricle systolic volume. Patients were divided in two groups: ischemic and non-ischemic based on personal history. Adverse events (HF related hospitalizations and deaths) were tracked for 33± 12.8 months. Results: 52 patients undergoing CRT were included (64±13.5 years, 55.7% male, 70% non-ischemic etiology) The two groups were similar considering LV systolic baseline parameters and volumes. Ischemic etiology was associated with non-LBBB morphology on ECG (p=0.03), a more severe LV diastolic dysfunction using E/e ratio (p<0.05), and a more severe RV dysfunction using TAPSE (p=0.008) and RV fractional area change (FAC) (p<0.05). There was no significant difference in CRT response between ischemic and non-ischemic etiology. 14 (26.9%) patients had events (10 hospitalizations and 4 deaths) with a higher prevalence in the ischemic group (58.33% vs 25%, p=0.01). Univariate Cox regression analysis reported a higher risk of cardiovascular events for ischemic etiology (HR 2.4, 95% CI [0.8-8.1], p <0.05). In our cohort there was no significant difference in use of an implantable cardioverter-defibrillator in addition to CRT between ischemic and non-ischemic group (64.2% respectively 63.3%, p =0.3). Conclusion: Our study shows that ischemic and nonischemic HF patients had similar response to CRT. However, ischemic etiology was associated with a higher risk ofadverse cardiovascular events and a worse RV systolic dysfunction at baseline.

Highlights

Cardiac resynchronization therapy (CRT) is an efficient therapeutic approach for the management of patients with symptomatic heart failure (HF) with reduced left ventricular ejection fraction (LVEF) ≤ 35% and a QRS duration of ≥ 130ms with left bundle branch block (LBBB)/non-LBBB morphology 1,2
Our study provides valuable information about the influence of heart failure with reduced ejection fraction (HfrEF) etiology on CRT patients outcome
Ischemic etiology is associated with nonLBBB morphology on ECG, more severe left ventricle (LV) diastolic dysfunction at baseline

Summary

Introduction

Cardiac resynchronization therapy (CRT) is an efficient therapeutic approach for the management of patients with symptomatic heart failure (HF) with reduced left ventricular ejection fraction (LVEF) ≤ 35% and a QRS duration of ≥ 130ms with left bundle branch block (LBBB)/non-LBBB morphology 1,2. Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HfrEF). Objective: to evaluate whether etiology (ischemic vs non-ischemic) influences the response to CRT and overall outcome. Results: 52 patients undergoing CRT were included (64±13.5 years, 55.7% male, 70% non-ischemic etiology) The two groups were similar considering LV systolic baseline parameters and volumes. There was no significant difference in CRT response between ischemic and non-ischemic etiology. Ischemic etiology was associated with a higher risk of adverse cardiovascular events and a worse RV systolic dysfunction at baseline.

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Conclusion