ABC Heart Fail Cardiomyop 2024; 4(2): e20240008
De Novo Versus Upgrade Cardiac Resynchronization Therapy in Patients with Heart Failure: A Cohort Study
William Carvalho
, Luíz Carlos Santana Passos
, Tainá Teixeira Viana, Gustavo Pinheiro Santana
, Jackson Pedro Barros-Pereira
, Fernanda Pinheiro Martin Tapioca
, Caio Rebouças Fonseca Cafezeiro
Abstract
Background:
Cardiac resynchronization therapy (CRT) is beneficial for patients with heart failure (HF) who have left bundle branch block. However, the benefits of CRT in patients with prior cardiac stimulation remain uncertain.
Objective:
Compare short-term mortality between upgrade and de novo CRT implantation.
Methods:
This prospective cohort study included patients with HF indicated for CRT with left ventricular ejection fraction (LVEF) below 35%. Overall survival was assessed using the Kaplan–Meier method, and multivariate analysis was performed using a Cox regression model.
Results:
A total of 412 patients were evaluated, with a mean follow-up of 59 ± 8 months. Of these, 104 patients were in the upgrade group, while 308 patients were included in the de novo group. Chagas disease was the most prevalent cause of HF, accounting for 148 cases (36%). While the de novo group progressed with an increase in LVEF (from 25% ± 6.7% to 28% ± 16.3%, p = 0.005), patients who underwent upgrade did not show a statistically significant difference in LVEF at 6 months (from 27.5% ± 6.9% to 27.5% ± 15.5%, p = 0.6). Overall mortality at 1 year was 122 cases (29.6%). In multivariate analysis, only LVEF and CRT upgrade remained independently associated with the outcome (hazard ratio: 0.93, confidence interval: 0.90 to 0.97, p = 0.001 and hazard ratio: 2.90, confidence interval: 1.21 to 7.10, p = 0.002, respectively).
Conclusion:
In this population with HF, the upgrade group was associated with higher 1-year mortality when compared with the de novo group.
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