P3868Effectiveness of cardiac resynchronization therapy in heart failure patients with valvular heart disease: comparison with patients with dilated cardiomyopathy

Abstract

Introduction: Heart failure (HF) may occur in the presence of a wide range of underlying heart diseases, including valvular heart disease (VHD). In the majority of randomized clinical trials that validated the clinical use of cardiac resynchronization therapy (CRT), the presence of a clinically significant VHD or of previous valvular surgery were exclusion criteria. The aim of this study was to analyze the effectiveness of CRT in patients with valvular heart in comparison with dilated cardiomyopathy (DCM) patients. Methods: Retrospective single-centre study that included all patients submitted to CRT therapy between January 2006 and December 2015. For the aims of current analysis, the following groups were considered: 1) patients with VHD (evidence of clinically significant primary valvular disease or previous valve replacement or repair for organic valvular disease; 2) patients with DCM (presence of a typical pattern of this heart disease, without ischaemic or organic valvular heart diseases). The response to CRT was evaluated comparing the baseline with 6 month follow-up echo data. In long term follow-up we evaluated all-cause mortality, transplantation rate and admissions for heart failure. Results: A total of 431 patients submitted to CRT in our centre were included. Of these, 199 patients (46%) had DCM and 26 (6.0%) had VHD. Age did not differ between groups [65 (+11) vs 69 (+9) years, p=0.253)]. There were no differences between the distribution of Diabetes Mellitus (29% vs 24%, p=0.574), hypertension (51% vs 42%, p=0.531), dyslipidemia (62% vs 75%, p=0, 331) and chronic kidney disease (29% vs 53%, p=0.07). The distribution of LBBB (82% vs 89%, p=0.402), and basal LV end diastolic volume [219 (104) vs 210 (110), p=0.867] was similar between groups. At 6 months echo, there was a trend to a more positive response to CRT in group of patients with DCM (55% vs 49%, p=0.06). Interestingly, group 1 patients were more frequently super responders (29 vs 6.3%, p=0.04). The mean follow up was 42 (+33) months. Mortality (18% vs 35%, p=0.04) was significantly lower in dilated cardiomyopathy. Both groups did not differ in transplantation rate (6.1 vs 3.8, p=0.538) and admissions for acute heart failure (29% vs 35%,p=0.33). The survival curves for all-cause mortality obtained by Kaplan-Meier analysis are shown in Figure1 and revealed a worse prognosis of patients with VHD (Log-rank test, P=0,037). In multivariate logistic regression analysis, the presence of Diabetes Mellitus [4.0 (1.1-16), p=0.04] and the valvular disease etiology [6.1 (1.1-33), p=0.03] significantly increased the risk, while responsiveness to CRT proved to have a significant protective role in the whole patient population [0.13 (0.03-0.4), p=0.02]. Conclusions: No randomized controlled trial has specifically evaluated the ef-fects of CRT in patients affected by a valvular heart disease, but on the basis of real world clinical practice, CRT appears more effective in DCM than VHD. (Table Presented) .