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The predictive role of mitral regurgitation in heart failure patients of different etiology, undergoing cardiac resynchronization therapy

Session Poster session 2

Speaker Peter Perge

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Poster Session
  • FP Number : P1175

Authors : P Perge (Budapest,HU), C Liptai (Budapest,HU), KV Nagy (Budapest,HU), AM Boros (Budapest,HU), A Apor (Budapest,HU), L Geller (Budapest,HU), G Szeplaki (Budapest,HU), B Merkely (Budapest,HU)

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Authors:
P Perge1 , C Liptai1 , KV Nagy1 , AM Boros1 , A Apor1 , L Geller1 , G Szeplaki1 , B Merkely1 , 1Semmelweis University, Heart and Vascular Center - Budapest - Hungary ,

Citation:

PURPOSE: Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected groups of heart failure (HF) patients, altough the predictors of non-response are not fully recognized. Ischemic cardiomyopathy is associated with worse clinical response to CRT, furthermore coronary artery disease (CAD) patients with significant mitral regurgitation (MR) have higher mortality risk regardless the presence of HF. The purpose of our study was to assess the impact of MR on clinical outcomes in ischemic (ICM) and non-ischemic HF (DCM) patients undergoing CRT.

METHODS: We enrolled 117 consecutive patients undergoing CRT, the follow-up period lasted for 5 years. The primary end-point was 5-year all-cause mortality, the compostie endpoit of 2-year HF hospitalization and mortality was considered as secondary end-point.  Echocardiographic measurements were taken off-line, MR were quantifyed using the PISA method, according to recent EACVI guidelines. We created to groups based on the baseline MR, moderate or more severe MR was considered as „significant MR".

RESULTS: The mean age of patients were 70.2±10.3 years, 55% suffered from HF of ischemic origin, 78 % were male. Among patients with ICM the ratio of males (p=0.04) and use of diuretics (p=0.04) were significantly higher. During follow-up 42 patients reached the primary, while 12 the secondary end-point. Ischemic etiology (p=0,816) and the severity of baseline MR (p=0,28) did not predicited 5-year mortality, the two-year combined end-point was not significantly associated with baseline MR (p=0.22). Significant MR at six months after implantation predicted the risk of secondary end-point, in case of long term mortality we found a strong trend (p=0.058). We analyzed the clinical response in groups formed according to severity of MR and etiology of HF. 5-year mortality significantly differed among groups (p=0.017), patients with mild MR and DCM showed the best response, while the significant MR-ICM group had the worst outcome. CONCLUSION: Baseline MR was not associated with clinical outcomes after CRT. On the other hand persisting significant MR predicted increased risk of mortality and morbidity regardless of HF etiology. Based on our results in ICM patients with persisting significant MR poor prognosis can be anticipated after CRT implantation.



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