de la Cruz Elena, Cortés Marcelino, Farré Jerónimo, Palfy Julia, Ávila Paloma, Hernández Ignacio, Romero Angélica, Benezet Juan, Franco Juan Antonio, Navas Miguel Angel, Hernandez Jose Joel, Briongos Sem, Rubio José M
Hospital Universitario Fundación Jiménez Díaz - idcsalud, Universidad Autónoma de Madrid, Madrid, Spain.
J Interv Card Electrophysiol. 2015 Jun;43(1):13-20. doi: 10.1007/s10840-015-9979-2. Epub 2015 Feb 17.
The role of cardiac resynchronization therapy (CRT) in patients aged ≥75 years is not well established.
We identified 607 patients aged ≥75 years with left ventricular ejection fraction (LVEF) of ≤35 %, of whom 78 met the guidelines for indication of CRT. Based on the decision of the patients or attending cardiologists, 34 patients received a CRT defibrillator (CRT-D).
The age of patients with a CRT indication was 80 ± 4 years, and 73 % were males. As compared with patients on medical therapy, CRT-D patients were younger (79 ± 3 vs. 83 ± 4, P < 0.001), had lower LVEF (23 ± 7 vs. 27 ± 7 %, P = 0.008) and higher rate of decompensated heart failure episodes (77 vs. 55 %, P = 0.04), were more frequently New York Heart Association (NYHA) class III-IV (53 vs. 25 %, P = 0.01), and were more likely to be on beta-blockers (88 vs. 66 %, P = 0.023), anticoagulants (61 vs. 32 % P = 0.02), and anti-aldosterone drugs (82 vs. 50 %, P = 0.003). After a median follow-up of 26 months, seven patients in the CRT-D group (21 %) and 20 non-CRT patients (46 %) died (hazard ratio (HR) 0.16 [95 % confidence interval (CI) 0.06-0.46]). The end point of mortality or hospitalization was not reduced because of a similar rate of hospitalizations for heart failure of CRT-D patients. Four CRT-D patients (12 %) had received appropriate device therapy, and one had been inappropriately discharged. During follow-up, 44 % of CRT-D patients improved their LVEF by >40 %.
CRT-D is potentially of benefit in terms of mortality in our population; this effect persists after correction for use of beta-blockers. In patients ≥75 years, CRT indications should be similar to those accepted for younger subjects.
心脏再同步治疗（CRT）在75岁及以上患者中的作用尚未明确。
我们纳入了607例年龄≥75岁、左心室射血分数（LVEF）≤35%的患者，其中78例符合CRT适应证标准。根据患者或主治心脏病专家的决定，34例患者接受了CRT除颤器（CRT-D）治疗。
有CRT适应证的患者年龄为80±4岁，73%为男性。与接受药物治疗的患者相比，接受CRT-D治疗的患者更年轻（79±3岁 vs. 83±4岁，P<0.001），LVEF更低（23±7% vs. 27±7%，P=0.008），失代偿性心力衰竭发作率更高（77% vs. 55%，P=0.04），纽约心脏协会（NYHA）心功能分级为III-IV级的比例更高（53% vs. 25%，P=0.01），且更有可能使用β受体阻滞剂（88% vs. 66%，P=0.023）、抗凝剂（61% vs. 32%，P=0.02）和抗醛固酮药物（82% vs. 50%，P=0.003）。中位随访26个月后，CRT-D组有7例患者（21%）死亡，20例未接受CRT治疗的患者（46%）死亡（风险比（HR）0.16[95%置信区间（CI）0.06-0.46]）。由于CRT-D治疗患者的心力衰竭住院率相似，因此死亡率或住院率这一终点未降低。4例CRT-D治疗患者（12%）接受了适当的器械治疗，1例出现不适当放电。随访期间，44%的CRT-D治疗患者LVEF提高超过40%。
在我们的研究人群中，CRT-D在降低死亡率方面可能有益；在校正β受体阻滞剂的使用后，这种效果仍然存在。在75岁及以上的患者中，CRT的适应证应与年轻患者相同。
