Guha K, Konstantinou D, Mantziari L, Modi B N, Chandrasekaran B, Khalique Z, McDonagh T, Sharma R
Department of Cardiology, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK.
J Interv Card Electrophysiol. 2014 Jan;39(1):95-102. doi: 10.1007/s10840-013-9844-0. Epub 2013 Nov 29.
Cardiac resynchronisation therapy (CRT) is an established treatment for selected patients with symptomatic left ventricular (LV) systolic dysfunction. Heart failure (HF) is primarily a disease of the elderly; however, these patients are underrepresented in CRT trials. Our aim was to evaluate the impact of age on clinical outcomes following CRT.
A consecutive series of 177 patients was identified and divided into those aged ≤ 7 5 years (n = 131, mean ± SD 62.1 ± 11.2 years) and those aged >75 years (n = 46, mean ± SD 80.7 ± 4.1 years). The primary end point was a composite of all-cause mortality or HF hospitalisation.
During a median ± IQR follow up of 28.5 ± 33.7 months, the event rate for the primary end point was significantly higher in the elderly compared to younger patients (20.1 vs. 11.1 %, respectively, logrank p = 0.020). This was mainly driven by an excess mortality rate among those aged >75 years (10 vs. 4.7%, respectively, logrank p = 0.018) whereas HF hospitalisation rates were similar between groups (10 vs. 6.4%, respectively, logrank p = 0.301). After adjusting for comorbidities and ICD status, the difference in the composite end point rates was attenuated and no longer significant (HR 1.580, 95% CI 0.899-2.778; p = 0.112 for >75 vs. ≤ 75 years). Notably, both groups demonstrated similar response rates to CRT in terms of symptomatic improvement, reverse LV remodelling and neurohormonal activation.
CRT is equally effective in the elderly as in younger patients to reduce adverse clinical outcomes. For those who fulfil the prerequisite selection criteria, it should be considered as a valid therapeutic option.
心脏再同步治疗（CRT）是针对有症状的左心室（LV）收缩功能障碍的特定患者的既定治疗方法。心力衰竭（HF）主要是一种老年疾病；然而，这些患者在CRT试验中的代表性不足。我们的目的是评估年龄对CRT后临床结局的影响。
连续纳入177例患者，分为年龄≤75岁组（n = 131，平均±标准差62.1±11.2岁）和年龄>75岁组（n = 46，平均±标准差80.7±4.1岁）。主要终点是全因死亡率或HF住院的复合终点。
在中位±四分位间距随访28.5±33.7个月期间，老年患者的主要终点事件发生率显著高于年轻患者（分别为20.1%和11.1%，对数秩检验p = 0.020）。这主要是由年龄>75岁者的过高死亡率驱动的（分别为10%和4.7%，对数秩检验p = 0.018），而两组间HF住院率相似（分别为10%和6.4%，对数秩检验p = 0.301）。在调整合并症和植入式心律转复除颤器（ICD）状态后，复合终点率的差异减弱且不再显著（年龄>75岁组与年龄≤75岁组相比，风险比1.580，95%置信区间0.899 - 2.778；p = 0.112）。值得注意的是，两组在症状改善、左心室逆向重构和神经激素激活方面对CRT的反应率相似。
CRT在老年患者和年轻患者中对减少不良临床结局同样有效。对于符合必要入选标准的患者，应将其视为一种有效的治疗选择。
