Strisciuglio Teresa, Stabile Giuseppe, Pecora Domenico, Arena Giuseppe, Caico Salvatore Ivan, Marini Massimiliano, Pepi Patrizia, D'Onofrio Antonio, De Simone Antonio, Ricciardi Giuseppe, Badolati Sandra, Spotti Alfredo, Casu Gavino, Solimene Francesco, La Greca Carmelo, Ammirati Giuseppe, Pergola Valerio, Addeo Lucio, Malacrida Maurizio, Bertaglia Emanuele, Rapacciuolo Antonio
Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy.
Montevergine Clinic, 83013 Mercogliano, Italy.
J Clin Med. 2021 Apr 1;10(7):1451. doi: 10.3390/jcm10071451.
More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years.
Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65 (group A), 65-74 (group B) and ≥75 years (group C). Mortality, hospitalization, and composite event rate were evaluated at 1 year and during long-term follow-up.
Patients ( = 934) were distributed as follows: group A 242; group B 347; group C 345. On 12-month follow-up examination, 63% of patients ≥ 75 years displayed a positive clinical response. Mortality was significantly higher in patients ≥ 75 years than in the other two groups, although the rate of hospitalizations for HF worsening was similar to that of patients aged 65-74 (7 vs. 9.5%, respectively; = 0.15). Independent predictors of death and of negative clinical response were age >80 years, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Over long-term follow-up (1020 days (IQR 680-1362)) mortality was higher in patients ≥ 75 years than in the other two groups. Hospitalization and composite event rates were similar in patients ≥ 75 years and those aged 65-74 (9 vs. 11.8%; = 0.26, and 26.7 vs. 20.5%; = 0.06).
Positive clinical response and hospitalization rates do not differ between CRT recipients ≥ 75 years and those aged 65-74. However, age > 80 years, COPD and CKD are predictors of worse outcomes.
越来越多75岁及以上的心力衰竭（HF）患者接受心脏再同步治疗（CRT）设备植入，但关于其治疗结果及其预测因素的数据却很少。我们调查了75岁及以上CRT患者的中长期治疗结果及其预测因素。
心脏再同步治疗模块（CRT MORE）注册研究中的患者被分为三个年龄组：<65岁（A组）、65 - 74岁（B组）和≥75岁（C组）。在1年时以及长期随访期间评估死亡率、住院率和复合事件发生率。
患者（n = 934）分布如下：A组242例；B组347例；C组345例。在12个月的随访检查中，75岁及以上的患者中有63%显示出阳性临床反应。75岁及以上患者的死亡率显著高于其他两组，尽管因心力衰竭恶化而住院的发生率与65 - 74岁患者相似（分别为7%和9.5%；P = 0.15）。死亡和阴性临床反应的独立预测因素为年龄>80岁、慢性阻塞性肺疾病（COPD）和慢性肾脏病（CKD）。在长期随访（1020天（四分位间距680 - 1362））中，75岁及以上患者的死亡率高于其他两组。75岁及以上患者的住院率和复合事件发生率与65 - 74岁患者相似（分别为9%和11.8%；P = 0.26，以及26.7%和20.5%；P = 0.06）。
75岁及以上的CRT接受者与65 - 74岁的接受者之间的阳性临床反应和住院率没有差异。然而，年龄>80岁、COPD和CKD是预后较差的预测因素。
