Cardiovascular outcomes after cardiac resynchronization therapy in cardiac amyloidosis

ESC Heart Failure

François Jourda¹  Charles Guenancia²  Jean‐Christophe Eicher²  Gabriel Laurent²  Kilian Fischer²  Olivier Huttin³  Bruno Degand⁴  Rodrigue Garcia⁴  Raphaël Martins⁵  Guillaume Serzian⁶  François Lesaffre⁷  Madeline Espinosa⁷  Jean‐Baptiste Guichard⁸  Nicolas Clementy⁹  Arnaud Bisson⁹  Thibaud Damy^1,10  Nicolas Lellouche^1,10  Hervé Devilliers^1,11 

[1] Department of Cardiology Auxerre Hospital Auxerre France;Department of Cardiology Dijon University Hospital 14 rue Paul Gaffarel Dijon 21079 France;Department of Cardiology Nancy University Hospital Nancy France;Department of Cardiology Poitiers University Hospital Poitiers France;Department of Cardiology Pontchaillou Hospital Rennes France;Department of Cardiology Regional University Hospital Jean Minjoz Besançon France;Department of Cardiology Reims University Hospital Reims France;Department of Cardiology Saint‐Etienne University Hospital Saint‐Étienne France;Department of Cardiology Tours University Hospital Tours France;Department of Cardiology, Referral Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, DHU‐ATVB, Inserm U955 University Hospital Henri Mondor Créteil France;Inserm CIC 1432 University of Burgundy Dijon France;

关键词: Cardiac amyloidosis;    Cardiac resynchronization therapy;    Heart failure;    Pacemaker;    Implantable cardioverter defibrillator;   

DOI  :  10.1002/ehf2.13663

来源: DOAJ

【 摘 要 】

Abstract Aims Cardiac resynchronization therapy (CRT) is highly effective in dilated cardiomyopathy (DCM) patients with impaired left ventricular ejection fraction (LVEF) and left bundle block branch. In cardiac amyloidosis (CA) patients, left ventricular dysfunction and conduction defects are common, but the potential of CRT to improve cardiac remodelling and survival in this particular setting remains undefined. We investigated cardiovascular outcomes in CA patients after CRT implantation in terms of CRT echocardiographic response and major cardiovascular events (MACEs). Methods and results Our retrospective study included 47 CA patients implanted with CRT devices from January 2012 to February 2020, in nine French university hospitals (77 ± 6 years old, baseline LVEF 30 ± 8%) compared with propensity‐matched (1:1 for age, LVEF at implantation, and CRT indication) DCM patients with a CRT device. CA patients had lower rates of CRT response (absolute delta LVEF ≥ 10%) compared with DCM patients (36% vs. 70%, P = 0.002). After multivariate Cox analysis, CA was independently associated with MACE (hospitalization for heart failure/cardiovascular death) [hazard ratio (HR) 3.73, 95% confidence interval (CI) 1.85–7.54, P < 0.001], along with the absence of CRT response (HR 3.01, 95% CI 1.56–5.79, P = 0.001). The presence of echocardiographic CRT response (absolute delta LVEF ≥ 10%) was the only predictive factor of MACE‐free survival in CA patients (HR 0.36, 95% CI 0.15–0.86, P = 0.002). Conclusion Compared with a matched cohort of DCM patients, CA patients had a lower rate of CRT response and consequently a worse cardiovascular prognosis after CRT implantation. However, CRT could be beneficial even in CA patients given that CRT response was associated with better cardiac outcomes in this population.

【 授权许可】

Unknown