Left Ventricular Reverse Remodeling, Device-Related Adverse Events, and Long-Term Outcome After Cardiac Resynchronization Therapy in the Elderly

作者：Hoeke Ulas; Putter Hein; Van der Velde Enno T; Schalij Martin J; Delgado Victoria; Bax Jeroen J; Marsan Nina Ajmone^*

来源：Circulation-Cardiovascular Quality and Outcomes, 2014, 7(3): 437-444.

DOI：10.1161/CIRCOUTCOMES.113.000821

• aged
• cardiac resynchronization therapy
• heart failure
• prognosis

Background-Limited data are available on efficacy, safety, and long-term prognosis after cardiac resynchronization therapy (CRT) in elderly patients. We aimed at evaluating the effect of CRT, device-related adverse events, and long-term outcome after CRT among elderly patients.
Methods and Results-A total of 798 CRT recipients (208 elderly: age, >= 75 years; 590 nonelderly: age, <75 years) underwent clinical and echocardiographic evaluation at baseline and 6-month follow-up. Elderly patients had similar improvements in clinical symptoms, left ventricular function, and left ventricular reverse remodeling as their counterparts. Similar rates of device-related in-hospital (within 24 hours; P=0.552), early (within 30 days; P=0.984), and long-term adverse events (entire follow-up; hazard ratio, 0.90; P=0.620) were observed between groups. During long-term follow-up (median, 38.6 months; interquartile range, 22.5-61.8 months), all-cause mortality rate was significantly higher among the elderly patients. However, the differences in cumulative event rates started after 4 years of follow-up (P=0.013), and the cause of death was mainly noncardiac (29% in the elderly versus 19% in nonelderly; P<0.001). Diabetes mellitus (hazard ratio, 2.322; P=0.019), impaired renal hazard ratio, 0.975; P=0.006), and reduced 6-minute walk distance (hazard ratio, 0.996; P<0.019) were independently associated with all-cause mortality in elderly patients.
Conclusions-CRT efficacy and device-related adverse events in elderly patients were comparable with that of nonelderly patients. However, after 4 years of follow-up, elderly patients showed worse survival and the cause of death was mainly noncardiac. Diabetes mellitus, impaired renal function, and reduced 6-minute walk distance were independently associated with all-cause mortality of elderly patients.

• 出版日期2014-5