Heart Failure -> Cardiac Resynchronization Therapy: -> Indications D-AB13 - Beyond ICM and NICM: CRT in Emerging HF Populations (ID 54) Abstract

D-AB13-04 - Impact Of Cardiac Resynchronization Therapy On Survival In Patients With Transthyretin Cardiac Amyloidosis (ID 1432)


Background: Reduced ejection fraction (EF) is a poor prognostic feature among patients with transthyretin cardiac amyloidosis (ATTR-CA). There is currently a lack of data in the literature investigating the role of cardiac resynchronization therapy (CRT) in these patients.
Objective: To investigate the impact of cardiac resynchronization therapy on survival in patients with ATTR-CA.
Methods: This was a retrospective cohort study of 30 consecutive patients with ATTR-CA who underwent CRT implantation. These patients were matched on the basis of age, gender, EF, NYHA functional class and ATTR-CA stage with 30 patients without CRT devices.
Results: Baseline characteristics are shown in Figure 1a. Of the 30 patients with CRT devices, 21 (70%) had CRT-D, while 9 (30%) had CRT-P. Among the 21 patients with CRT-D, 20 (67%) had an EF < 35% at the time of implant. Of these, 14 (70%) were responders, 8 (40%) were super-responders and 6 (30%) were non-responders. The mean % of BiV pacing was 94±9%. During a mean follow-up of 30±24 months, death occurred in 18 (60%) patients with and 25 (83%) patients without CRT devices (Figure 1b, p=0.002). On Cox proportional hazards analyses, CRT was associated with improved survival (HR 0.39, 95% CI 0.21-0.74, p=0.003), while more advanced ATTR-CA stage was associated with increased mortality (HR 1.8, 95% CI 1.12-2.86, p=0.014).
Conclusion: Although mortality was high in both groups, CRT devices were associated with improved survival in patients with ATTR-CA. These findings will need to be validated in future prospective studies.