P3801The impact of the type of response to cardiac resynchronization therapy in the survival of patients with advanced heart failure

Abstract Fundamental Cardiac resynchronization therapy (CRT) reduces total mortality in patients (pt) with advanced heart failure (HF). However, the impact of this reduction is unknown in the different types of response. Objective To describe the survival of responders and super responders pt to CRT in a retrospective cohort. Methods 250 pt who underwent a CRT were retrospectively evaluated. All presented in functional class (FC) III/ IV (NYHA). The criteria of response to CRT were: improvement of FC (>1); increase in ejection fraction (EF) >10% and decrease in left ventricular end-systolic diameter (LVESD) – >15%. They were divided into three groups: Group I – 73/250 pt (33%): responder only by the criterion of FC improvement. Group II - 57/250 pt (24%): responder was defined by three criteria (clinical and echocardiographic). Grupo III - super responder – 48/250 pt (20%): decrease >30% in LVESD and/or EF >45%. The survival and clinical outcomes were analyzed in the 3 groups. Results In group I, the mean age was 68.7 years; 75% were male; left bundle branch block (LBBB) was observed in 93% and average QRS duration was 164 ms; EF: 26%; average LVESD and left ventricular end-diastolic diameter (LVEDD): 46 and 57.7 mm, respectively. BIV-ICD was observed in 72% of pt. The mean post-implant survival was 30.8 months (CI95%: 25.06–36.54). In group II, the mean age was 70 years; 82% were male; left bundle branch block (LBBB) was observed in 98% and average QRS duration was 166 ms; EF: 27.5%; average LVESD and LVEDD: 52 and 67 mm, respectively. BIV-ICD was observed in 75% of pt. The mean post-implant survival was 45.4 months (CI95%: 38.96–51.84). In group III, the mean age was 71 years; 65% were male; left bundle branch block (LBBB) was observed in all pt (100%) and average QRS duration was 176 ms; EF: 29.2%; average LVESD and LVEDD: 54 and 68 mm, respectively. BIV-ICD was observed in 70% of pt. The mean post-implant survival was 53 months (CI95%: 45.96–60.04). The total mortality observed was 11%, 17% and 6.25%, respectively (48%: neoplasia; 24%: stroke; 19%: terminal HF; 9%: sepsis). Conclusion In the present study, the survival of responders pt to CRT varied according to the type of response, being significantly higher in the super responders and in those who presented echocardiographic criteria of response to CRT. These findings present significant clinical relevance and should be evaluated in future studies.