Cardiac resynchronization therapy is effective even in elderly patients with comorbidities

Abstract

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 cm 2 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.

Outcomes of Cardiac Resynchronization Therapy in the Elderly

“…Although baseline NYHA and LVEF were similar between the two age groups, a higher proportion of younger recipients had NICM. Older patients are more likely to receive CRT‐P alone than in combination with a defibrillator . This may be associated with preference for improving quality of life rather than providing lifesaving shocks in older patients with HF.…”

“…Older patients are more likely to receive CRT-P alone than in combination with a defibrillator. 5,6 This may be associated with preference for improving quality of life rather than providing lifesaving shocks in older patients with HF. Alternatively, CRT-P may improve LVEF, such that ICD placement may not be indicated.…”

Comparison of pharmacological treatment alone versus treatment combined with cardiac resynchronization therapy in patients over 75 years

“…However, no randomized controlled trials have addressed the value of CRT in elderly HF patients [22][23][24][25][26]. Elderly HF patients (≥75 years) have been underrepresented or excluded in the aforementioned CRT trials despite the fact that HF is more prevalent in the very elderly as compared with younger patients [1].…”

Cardiac resynchronization therapy in the elderly: A realistic option for an increasing population?

“…However, it has been demonstrated that renal impairment does not prevent the positive response to CRT, even in elderly patients [19]. Actually, previous studies have indicated that CRT can be a renal-protective strategy in HF and that the improvement in renal function can be another mechanism to explain the beneficial effects of CRT [20][21][22].…”

“…In addition, diabetes is a powerful independent predictor of morbidity and mortality among patients with HF [24]. Regarding the impact of diabetes on CRT effectiveness, previous studies have demonstrated that this frequent comorbidity is not a predictor of poor response [19,25]. In fact, diabetic HF patients treated with CRT seem to have a very favorable functional and survival outcome, which is comparable to non-diabetic patients [26].…”