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94 Mid-wall fibrosis and outcomes in non-ischaemic cardiomyopathy and cardiac resynchronisation therapy
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  1. Aamir Shamsi1,
  2. Victor Voon1,
  3. Wai-Yan Lau1,
  4. Helder Pereira1,
  5. Nesan Shanmugam1,
  6. Robin Ray1,
  7. Lisa Anderson2
  1. 1St George’s Hospital
  2. 2St Georges University Hospital

Abstract

Background Non-ischaemic cardiomyopathy has been associated with better left ventricular (LV) remodelling and outcomes post-cardiac resynchronisation therapy (CRT) but has separately been linked to poorer outcomes when associated with mid-wall fibrosis (MWF) on cardiac magnetic resonance. Therefore, we aimed to confirm the impact of MWF in patients with non-ischaemic cardiomyopathy and CRT.

Methods We retrospectively evaluated data from 164 consecutive patients with a diagnosis of non-ischaemic cardiomyopathy and CRT implants. Non-eligible patients were excluded (eg. ischaemic, amyloid or sarcoid cardiomyopathy, missing data). Patients with or without mid wall fibrosis (MWF+, n=69 vs MWF-, n=99), were compared and evaluated for major cardiovascular event (including all-cause mortality or hospitalizations for ventricular arrthythmias, heart failure or myocardial infarction) from time of CRT implant. Results were reported as mean ± SD. p≤0.05 was deemed statistically significant.

Results Mean age of patient cohort was 66 ± 14 years with total follow-up duration of 1140 ± 1018 days. Between the groups, no significant difference in baseline demographics was observed in terms of age, gender, comorbidities (hypertension/diabetes), medication profiles, electrocardiographic measures (intrinsic rhythm and QRS duration). MWF+ demonstrated lower LV ejection fraction (28 ± 10 vs 31 ± 13%, p=0.02) and higher LV end-systolic volume (211 ± 90 vs. 181 ± 96 ml, p=0.05) when compared to MWF-. However, there were no significant differences between MWF+ vs MWF- in terms of all-cause mortality (34% vs 24%, see Figure 1), or hospitalisations for ventricular arrhythmia (5% vs 2%) or heart failure (18% vs 22%), respectively.

Abstract 94 Figure 1

Kaplan-Meier demonstrating no significant difference in all-cause mortality in patients with non-ischaemic cardiomyopathy and cardiac resynchronization therapy with mid-wall fibrosis (MWF+) vs those without fibrosis (MWF−) over follow-up

Conclusion This retrospective study demonstrated that MWF+ was associated with lower LV ejection fraction and higher LV end-systolic volumes compared to MWF-. However, we observed no significant between-group diferrence in major adverse cardiovascular events. Further evaluation of this patient cohort in larger studies is warranted.

Conflict of Interest Nil

  • Mid-Wall Fibrosis
  • Non-Ischaemic Cardiomyopathy
  • Cardiac Resynchronisation Therapy

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