title: Cardiac resynchronization therapy improves functional status and cognition.
abstract: BACKGROUND
  Many trials demonstrated the beneficial effects on hospitalizations and mortality of cardiac resynchronization therapy (CRT). The purpose of this study was to evaluate CRT effects on functional performance and cognition, two determinants of disability, frailty development and survival.
  
  
  METHODS
  All consecutive patients receiving a CRT device were evaluated at baseline and at the 6-month follow-up. Functional profile was assessed with the Short Physical Performance Battery (SPPB), a measure exploring balance, gait, strength and endurance, highly predictive of incident disability and mortality. The Mini-Mental State Examination (MMSE) was used to study the cognitive profile.
  
  
  RESULTS
  We enrolled 54 patients; two of them died during the follow-up, two refused to continue the study. Age was 67±10years (men: 80%, LVEF: 28±5%); medical therapy was optimized (ACE-I/ARB: 84%, beta-blockers: 80%). After 6months, CRT was associated with the improvement of LVEF (35±8 vs. 28±5%, p<0.001) and NYHA Class (1.8±0.6 vs. 2.6±0.5, p<0.001), and with the reduction of left ventricular end-systolic diameter (50±9 vs. 57±9mm, p<0.001). SPPB improved in its total score (10.3±2.0 vs. 9.1±2.7, p<0.001) and in the scores exploring gait speed and strength and endurance. These changes were associated with a better cognitive profile (MMSE score: 27.0±3.5 vs. 25.9±4.8, p=0.009). Advanced age was an independent predictor of improved functional performance and cognition.
  
  
  CONCLUSIONS
  CRT is associated with higher functional and cognitive profile after only 6months of therapy. These findings let us hypothesize a powerful effect of treatment to slow disability and frailty development in heart failure.
authors.affiliation: Intensive Care Unit, Division of Geriatric Cardiology and Medicine, and Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy. Electronic address: fumadue@tin.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fumagalli
authors.affiliation: Electrophysiology Unit and Postgraduate School of Cardiology, Division of Internal Medicine and Cardiology, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pieragnoli
authors.affiliation: Electrophysiology Unit and Postgraduate School of Cardiology, Division of Internal Medicine and Cardiology, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ricciardi
authors.affiliation: Electrophysiology Unit and Postgraduate School of Cardiology, Division of Internal Medicine and Cardiology, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mascia
authors.affiliation: Emergency Cardiology Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Mascia
authors.affiliation: Electrophysiology Unit and Postgraduate School of Cardiology, Division of Internal Medicine and Cardiology, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Michelotti
authors.affiliation: Department of Arrhythmology, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Giosuè
authors.initials: G
authors.lastname: Mascioli
authors.affiliation: Electrophysiology Unit and Postgraduate School of Cardiology, Division of Internal Medicine and Cardiology, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Beltrami
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Padeletti
authors.affiliation: Electrophysiology Unit and Postgraduate School of Cardiology, Division of Internal Medicine and Cardiology, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Nesti
authors.affiliation: Intensive Care Unit, Division of Geriatric Cardiology and Medicine, and Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.affiliation: Electrophysiology Unit and Postgraduate School of Cardiology, Division of Internal Medicine and Cardiology, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy; Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000639:trends; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Cognitive impairment; Elderly; Frailty; Heart failure; SPPB