Cardiac resynchronization therapy is effective even in elderly patients with comorbidities.
OBJECTIVE
The purpose of this study was to compare the effects of cardiac resynchronization therapy (CRT) in elderly patients (> or =65 years) with younger patients and to assess the impact of comorbidities in CRT remodeling response.


METHODS
This is a prospective study of 87 consecutive patients scheduled for CRT who underwent clinical and echocardiographic evaluation before and 6 months after CRT. A reduction in left ventricular end-systolic volume (LVESV) > or =15% after CRT defined remodeling responders, and a reduction of at least one New York Heart Association class defined clinical responders. Multivariate analysis was used to identify independent predictors of non-response to CRT in terms of reverse remodeling.


RESULTS
The mean age was 62 +/- 11 years, with 36 elderly patients (41%). The baseline QRS duration was 145 +/- 32 ms. After CRT, there were significant and similar improvements of left ventricular (LV) ejection fraction, LVESV, LV dP/dt, and mitral regurgitation jet area (JA) between elderly (> or =65 years) and younger (<65 years) patients. The number of clinical and remodeling responders was comparable, and we found no significant differences in unplanned cardiac hospitalizations at 6 months between groups. Independent predictors of lack of remodeling response to CRT were QRS duration <120 ms, LV diastolic diameter >74 mm, and JA >10 cm(2) before CRT, but not comorbidities.


CONCLUSIONS
This work suggests that being elderly is not an impediment to CRT success even in the presence of comorbidities.
António
Natália
N
Department of Cardiology, Coimbra University Hospital and Medical School, Avenida Bissaya Barreto, 3000-076, Coimbra, Portugal. natalia.antonio@gmail.com
Lourenço
Carolina
C
Teixeira
Rogério
R
Saraiva
Fátima
F
Coelho
Lourenço
L
Ventura
Miguel
M
Cristóvão
João
J
Elvas
Luís
L
Gonçalves
Lino
L
Providência
Luís A
LA
D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome