Published in:
01-01-2010
Cardiac resynchronization therapy is effective even in elderly patients with comorbidities
Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2010
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Purpose
The purpose of this study was to compare the effects of cardiac resynchronization therapy (CRT) in elderly patients (≥65 years) with younger patients and to assess the impact of comorbidities in CRT remodeling response.
Methods
This is a prospective study of 87 consecutive patients scheduled for CRT who underwent clinical and echocardiographic evaluation before and 6 months after CRT. A reduction in left ventricular end-systolic volume (LVESV) ≥15% after CRT defined remodeling responders, and a reduction of at least one New York Heart Association class defined clinical responders. Multivariate analysis was used to identify independent predictors of non-response to CRT in terms of reverse remodeling.
Results
The mean age was 62 ± 11 years, with 36 elderly patients (41%). The baseline QRS duration was 145 ± 32 ms. After CRT, there were significant and similar improvements of left ventricular (LV) ejection fraction, LVESV, LV dP/dt, and mitral regurgitation jet area (JA) between elderly (≥65 years) and younger (<65 years) patients. The number of clinical and remodeling responders was comparable, and we found no significant differences in unplanned cardiac hospitalizations at 6 months between groups. Independent predictors of lack of remodeling response to CRT were QRS duration <120 ms, LV diastolic diameter >74 mm, and JA >10 cm2 before CRT, but not comorbidities.
Conclusion
This work suggests that being elderly is not an impediment to CRT success even in the presence of comorbidities.