Normandie University, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, EA4650 (Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique), 14000, Caen, France.
Normandie University, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France.
BMC Geriatr. 2019 Nov 21;19(1):325. doi: 10.1186/s12877-019-1351-4.
Cardiac resynchronization therapy has been shown to benefit selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in randomized trials. This study was conducted to determine whether predictive factors for cardiac resynchronization therapy outcomes differ in patients older and younger than 75 years of age.
Consecutive patients who received a cardiac resynchronization device cardiac resynchronization therapy between 2013 and 2016 in our center were retrospectively included in this cohort study. The primary endpoint was cardiac resynchronization therapy effectiveness, which was defined as survival for one year with both no heart failure hospitalization and improvement by one or more NYHA class. The secondary endpoints were mortality, complications, and device therapies.
Among the 243 patients included, 102 were ≥ 75 years old. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) < 75 years old and in 48 patients (47%) ≥75 years old (p = 0.69). NYHA class ≥III (OR = 6.02; CI95% [1.33-18.77], p = 0.002) was a predictive factor for cardiac resynchronization therapy effectiveness only in the ≥75-year-old group, while atrial fibrillation was independently negatively associated with the primary endpoint in the < 75-year-old group (OR = 0.28; CI95% [0.13-0.62], p = 0.001). The one-year mortality rate was 14%, with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%), with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference between groups considering device therapies.
At one year, cardiac resynchronization therapy response is not compromised by patient age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy.
心脏再同步治疗已被证明对射血分数降低的心力衰竭患者有益。年龄较大的患者在随机试验中代表性不足。本研究旨在确定 75 岁以上和以下的患者心脏再同步治疗结果的预测因素是否不同。
连续回顾性纳入 2013 年至 2016 年在我院接受心脏再同步治疗装置心脏再同步治疗的患者，进行这项队列研究。主要终点是心脏再同步治疗的有效性，定义为一年无心力衰竭住院且 NYHA 分级提高一级或一级以上的生存率。次要终点是死亡率、并发症和装置治疗。
在 243 名患者中，102 名患者年龄≥75 岁。在<75 岁的 70 名患者（50%）和≥75 岁的 48 名患者（47%）中观察到心脏再同步治疗的有效性（p=0.69）。仅在≥75 岁组中，NYHA 分级≥III（OR=6.02；95%CI [1.33-18.77]，p=0.002）是心脏再同步治疗有效性的预测因素，而在<75 岁组中，房颤与主要终点独立负相关（OR=0.28；95%CI [0.13-0.62]，p=0.001）。一年死亡率为 14%，两组间无差异。在两个年龄组中，挽救性心脏再同步治疗和房颤都是死亡的独立预测因素。在 45 名患者（19%）中发生了 82 次并发症，两组间无差异。在两个年龄组中，除颤器使用和 QRS 持续时间是并发症的独立预测因素。考虑到装置治疗，两组之间没有差异。
在一年时，患者年龄不会影响心脏再同步治疗的反应。在老年患者中，NYHA 分级≥III 的症状严重的患者心脏再同步治疗后预后更好。
