Appropriate device therapies after CRT-D implantation in the modern heart failure treatment era
I Martins Moreira, L Azevedo, I Fernandes, M Bernardo, M Pipa, P Carvalho, J Guimaraes, S Leao, R Margato, P Fontes, I Silveira, I MoreiraAbstract
Introduction
Cardiac resynchronization therapy with defibrillator (CRT-D) reduces mortality in patients with heart failure (HF) and reduced ejection fraction. However, available data on appropriate device therapies largely originate from the pre–modern heart failure treatment era. The impact of contemporary therapies, including angiotensin receptor–neprilysin inhibitors (ARNI) and sodium-glucose co-transporter-2 inhibitors (SGLT2i), on the burden of appropriate device therapies remains uncertain.
Purpose
To evaluate the association between ARNI and/or SGLT2i therapy and the occurrence of appropriate device therapies in patients with CRT-D.
Methods
We performed a single-center retrospective study of consecutive patients who underwent CRT-D implantation between January 2017 and April 2024. Patients were classified by baseline use of ARNI and/or SGLT2i versus neither. The primary endpoint was the occurrence of any appropriate device therapy (ATP or shock) during follow-up. Secondary endpoints included ATP and shock separately, and major adverse cardiovascular events (MACE), including cardiovascular mortality or HF hospitalization. Time-to-event analyses were performed using Kaplan–Meier methods, and groups were compared with log-rank tests.
Results
A total of 120 patients were included (median age 70 [IQR 64–75] years, 72.5% male, 59.2% non-ischemic, mean follow-up time of 35±24 months), of whom 69 (57.5%) were receiving ARNI and/or SGLT2i at baseline. Patients in the ARNI/SGLT2i group were slightly younger (median age 69 vs 70 years p=0.034). Other baseline characteristics were similar, except higher beta-blocker use in the ARNI/SGLT2i group (88.4% vs 74.5%, p=0.048). Kaplan–Meier analysis suggested trends toward lower incidence of device therapies (log-rank p=0.228) and MACE events (log-rank p=0.303) in the ARNI/SGLT2i group, with no statistically significant differences. These trends were consistent across ischaemic and non-ischaemic cardiomyopathy (log-rank p=0.197 and p=0.306, respectively). No statistically significant differences were observed in ATP (7.4% vs 15.7%, p=0.149), shock (4.4% vs 13.7%, p=0.070), cardiovascular mortality (10.3% vs 11.8%, p=0.799), and HF hospitalizations (14.7% vs 29.4%, p=0.051).
Conclusion
In this real-world CRT-D cohort, contemporary HF therapy with ARNI and/or SGLT2i was not associated with statistically significant differences in appropriate device therapies or MACE. These findings support the continued clinical benefit of CRT-D in patients receiving modern guideline-directed therapy.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.