心脏再同步治疗在老年人中的临床反应
Clinical response of cardiac resynchronization therapy in the elderly.
作者信息
Delnoy Peter Paul H M, Ottervanger Jan Paul, Luttikhuis Henk Oude, Elvan Arif, Misier Anand R Ramdat, Beukema Willem P, van Hemel Norbert M
机构信息
Isala klinieken, Utrecht University, Zwolle, The Netherlands.
出版信息
Am Heart J. 2008 Apr;155(4):746-51. doi: 10.1016/j.ahj.2007.11.009. Epub 2008 Feb 21.
BACKGROUND
Although prevalence of heart failure increases with age, in most clinical trials of cardiac resynchronization therapy (CRT), older patients are not included. Observational studies of effects of CRT in older patients had a small sample size. In the present study, the clinical and echocardiographic response to CRT in a larger group of elderly (age > 75 years) patients was evaluated.
METHODS
In this prospective observational study of 266 consecutive patients, CRT was performed in 107 elderly patients (40%) and 159 (60%) younger patients (age < or = 75 years). Echocardiographic and clinical parameters were evaluated at baseline and at 3, 12, and 24 months.
RESULTS
In the elderly group, mean age was 79 years compared with 67 years in patients aged < or = 75 years. Clinical baseline characteristics between the 2 groups were comparable. During follow-up, there was a comparable and sustained improvement in both groups according to New York Heart Association (NYHA) class, quality of life score, and left ventricular (LV) ejection fraction. Clinical response, defined as survival with improvement (> or = 1 score) of NYHA class without hospital admittance for heart failure, was seen in 67% and 69% (group aged < or = 75 years) versus 65% and 60% (group aged > 75 years) after 3 months and 1 year, respectively. Reverse LV remodeling defined as LV end-systolic volume reduction > or = 10% was seen in 79% and 87% (group aged < or = 75 years) versus 71% and 79% (group aged > 75 years) after 3 months and 1 year, respectively. Hospitalization for heart failure decreased significantly in both groups in the year after CRT. A subgroup analysis of 39 octogenarians (> 80 years) also showed a significant improvement in NYHA class and LV ejection fraction in this subgroup. Also, LV reverse remodeling occurred in a similar extent (75% and 84%) after 3 months and 1 year, respectively.
CONCLUSIONS
This study shows a clinical and echocardiographic improvement of CRT in patients aged > 75 years and even so in octogenarians.
背景
尽管心力衰竭的患病率随年龄增长而增加，但在大多数心脏再同步治疗（CRT）的临床试验中，老年患者未被纳入。关于CRT对老年患者影响的观察性研究样本量较小。在本研究中，评估了一大组老年（年龄>75岁）患者对CRT的临床和超声心动图反应。
方法
在这项对266例连续患者的前瞻性观察性研究中，107例老年患者（40%）和159例（60%）年轻患者（年龄≤75岁）接受了CRT治疗。在基线以及3个月、12个月和24个月时评估超声心动图和临床参数。
结果
老年组的平均年龄为79岁，而年龄≤75岁患者的平均年龄为67岁。两组之间的临床基线特征具有可比性。在随访期间，根据纽约心脏协会（NYHA）分级、生活质量评分和左心室（LV）射血分数，两组均有可比且持续的改善。临床反应定义为NYHA分级改善（≥1级）且未因心力衰竭住院的存活情况，3个月后，年龄≤75岁组为67%，年龄>75岁组为65%；1年后，年龄≤75岁组为69%，年龄>75岁组为60%。定义为左心室收缩末期容积减少≥10%的左心室逆向重构，3个月后，年龄≤成年组为79%，年龄>75岁组为71%；1年后，年龄≤75岁组为87%，年龄>75岁组为79%。CRT治疗后的一年中，两组因心力衰竭住院的情况均显著减少。对39例年龄≥80岁患者的亚组分析也显示，该亚组的NYHA分级和LV射血分数有显著改善。同样，3个月和1年后，左心室逆向重构的程度相似（分别为75%和84%）。
结论
本研究表明，CRT对年龄>75岁的患者甚至对80岁以上的患者在临床和超声心动图方面均有改善。
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