Predictors of total mortality and echocardiographic response for cardiac resynchronization therapy : a cohort study

• Autor(a) principal: Gazzoni, Guilherme Ferreira
• Data de Publicação: 2017
• Outros Autores: Fraga, Matheus Bom, Ferrari, Andrés Di Leoni, Soliz, Pablo da Costa, Borges, Anibal Pires, Bartholomay, Eduardo, Kalil, Carlos Antonio Abunader, Giaretta, Vanessa, Rohde, Luis Eduardo Paim
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFRGS
• Texto Completo: http://hdl.handle.net/10183/180811
• topic: Terapia de ressincronização cardíaca; Insuficiência cardíaca; Volume sistólico; Bloqueio de ramo; Mortalidade; Estudos de coortes; Brasil; Heart failure / mortality; Cardiac resynchronization therapy; Stroke volume; Bundle-branch block; Cohort studies

Background: Clinical studies demonstrate that up to 40% of patients do not respond to cardiac resynchronization therapy (CRT), thus, appropriate patient selection is critical to the success of CRT in heart failure. Objective: Evaluation of mortality predictors and response to CRT in the Brazilian scenario. Methods: Retrospective cohort study including patients submitted to CRT in a tertiary hospital in southern Brazil from 2008 to 2014. Survival was assessed through a database of the State Department of Health (RS). Predictors of echocardiographic response were evaluated using Poisson regression. Survival analysis was performed by Cox regression and Kaplan Meyer curves. A two-tailed p value less than 0.05 was considered statistically significant. Results: A total of 170 patients with an average follow-up of 1011 ± 632 days were included. The total mortality was 30%. The independent predictors of mortality were age (hazard ratio [HR] of 1.05, p = 0.027), previous acute myocardial infarction (AMI) (HR of 2.17, p = 0.049) and chronic obstructive pulmonary disease (COPD) (HR of 3.13, p = 0.015). The percentage of biventricular stimulation at 6 months was identified as protective factor of mortality ([HR] 0.97, p = 0.048). The independent predictors associated with the echocardiographic response were absence of mitral insufficiency, presence of left bundle branch block and percentage of biventricular stimulation. Conclusion: Mortality in patients submitted to CRT in a tertiary hospital was independently associated with age, presence of COPD and previous AMI. The percentage of biventricular pacing evaluated 6 months after resynchronizer implantation was independently associated with improved survival and echocardiographic response. (Arq Bras Cardiol. 2017; 109(6):569-578)