Clinical outcomes and mortality in old and very old patients undergoing cardiac resynchronization therapy

English version

Autoři: Luiz Eduardo Montenegro Camanho ^aff001; Eduardo Benchimol Saad ^aff002; Charles Slater ^aff002; Luiz Antonio Oliveira Inacio Junior ^aff002; Gustavo Vignoli ^aff002; Lucas Carvalho Dias ^aff002; Pedro Pimenta de Mello Spineti ^aff001; Ricardo Mourilhe-Rocha ^aff001
Působiště autorů: Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil ^aff001; Serviço de Cardiologia e Arritmia Invasiva, Hospital Pró-Cardíaco, Rio de Janeiro, Brasil ^aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225612

Souhrn

Aim

Cardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total mortality of patients undergoing CRT. The secondary end point was to assess the rate of acute complications related to the procedure.

Methods and results

A total of 249 consecutive patients with HF and optimized treatment, QRS ≥ 120 ms, ejection fraction (EF) ≤ 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I—< 65 years—88/ 249 (35%); Group II– 65 to 75 years (old)– 72/ 249 (29%); Group III—≥ 75 years (very old)– 89/ 249 (36%). The improvement in FC and increase in EF (>10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns).

Conclusion

The response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications.

Klíčová slova:

Death rates – Medical devices and equipment – Medical implants – Geriatrics – Elderly – Echocardiography – Heart failure – Prosthetics

Zdroje

1. Albuquerque DC, Neto JD, Bacal F, Rohde LE, Bernardez-Pereira S, Berwanger O, et al. BREATHE IE. I Brazilian Registry of Heart Failure—Clinical Aspects, Care Quality and Hospitalization Outcomes. Arq Bras Cardiol 2015 Jun;104:433–442. doi: 10.5935/abc.20150031 26131698

2. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al, on behalf of the American Heart Association Advocacy Coordinating Committee, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Radiology and Intervention, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Stroke Council. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 2013 May;6:606–619. doi: 10.1161/HHF.0b013e318291329a 23616602

3. Van Riet EE, Hoes AW, Limburg A, Landman MA, van der Hoeven H, Rutten FH. Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail 2014 Jul;16:772–777. doi: 10.1002/ejhf.110 24863953

4. Cleland JG, McDonagh T, Rigby AS, Yassin A, Whittaker T, Dargie HJ. The national heart failure audit for England and Wales 2008–2009. Heart 2011 Jun;97:876–886. doi: 10.1136/hrt.2010.209171 21173198

5. Harjola VP, Follath F, Nieminen MS, Brutsaert D, Dickstein K, Drexler H, et al. Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. Eur J Heart Fail 2010 Mar;12:239–248. doi: 10.1093/eurjhf/hfq002 20156940

6. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, et al. Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001 Mar;344:873–880. doi: 10.1056/NEJM200103223441202 11259720

7. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al, for the Cardiac Resynchronization—Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005 Apr;352:1539–1549. doi: 10.1056/NEJMoa050496 15753115

8. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al, for the MIRACLE Study Group. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002 Jun;346:1845–1853. doi: 10.1056/NEJMoa013168 12063368

9. Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, et al. Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 2002 Jul;40:111–118. doi: 10.1016/s0735-1097(02)01932-0 12103264

10. Olechowski B, Sands R, Zachariah D, Andrews NP, Balasubramaniam R, Sopher M, et al. Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly? J Geriatr Cardiol 2015 Sep;12:497–501. doi: 10.11909/j.issn.1671-5411.2015.05.003 26512240

11. Jessup M, Brozena S. Heart failure. N Engl J Med 2003 May;348:2007–2018. doi: 10.1056/NEJMra021498 12748317

12. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 2003 Nov;290:2581–2587. doi: 10.1001/jama.290.19.2581 14625335

13. Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, et al, Investigators MIIRACLE ICD. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA 2003 May;289:2685–2694. doi: 10.1001/jama.289.20.2685 12771115

14. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al, for the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004 May;350:2140–215. doi: 10.1056/NEJMoa032423 15152059

15. Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al, for the MADIT-CRT Trial Investigators. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009 Oct;361:1329–1338. doi: 10.1056/NEJMoa0906431 19723701

16. Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et al, for the Resynchronization–Defibrillation for Ambulatory Heart Failure Trial (RAFT) Investigators. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med 2010 Dec;363:2385–2395. doi: 10.1056/NEJMoa1009540 21073365

17. Foley PW, Chalil S, Khadjooi K, Smith RE, Frenneaux MP, Leyva F. Long-term effects of cardiac resynchronization therapy in octogenarians: a comparative study with a younger population. Europace 2008 Nov;10:1302–1307. doi: 10.1093/europace/eun263 18827063

18. Achilli A, Turreni F, Gasparini M, Lunati M, Sassara M, Santini M, et al. Efficacy of cardiac resynchronization therapy in very old patients: the Insync/Insync ICD Italian Registry. Europace 2007 Sep;9:732–738. doi: 10.1093/europace/eum143 17636304

19. Bleeker GB, Schalij MJ, Molhoek SG, Boersma E, Steendijk P, van der Wall EE, et al. Comparison of effectiveness of cardiac resynchronization therapy in patients <70 versus > or = 70 years of age. Am J Cardiol 2005 Aug;96:420–422. doi: 10.1016/j.amjcard.2005.03.091 16054473

20. António N, Lourenço C, Teixeira R, Saraiva F, Coelho L, Ventura M, et al. Cardiac resynchronization therapy is effective even in elderly patients with comorbidities. J Interv Card Electrophysiol 2010 Jan;27:61–68. doi: 10.1007/s10840-009-9449-9 19937373

21. Verbrugge FH, Dupont M, De Vusser P, Rivero-Ayerza M, Van Herendael H, Vercammen J, et al. Response to cardiac resynchronization therapy in elderly patients (≥70 years) and octogenarians. Eur J Heart Fail 2013 Feb;15:203–210. doi: 10.1093/eurjhf/hfs151 23002114

22. Höke U, Putter H, Van Der Velde ET, Schalij MJ, Delgado V, Bax JJ, et al. Left ventricular reverse remodeling, device-related adverse events, and long-term outcome after cardiac resynchronization therapy in the elderly. Circ Cardiovasc Qual Outcomes 2014 May;7:437–444. doi: 10.1161/CIRCOUTCOMES.113.000821 24823954

23. Kowalik I, Ciszewski J, Dąbrowski R, Maciąg A, Syska P, Gepner K, et al. Clinical factors affecting long term survival in patients with systolic heart failure and cardiac resynchronization therapy in advanced age. Pol Merkur Lekarski 2018 Dec;45:220–225. 30693906

24. Daubert C, Behar N, Martins RP, Mabo P, Leclercq C. Avoiding non-responders to cardiac resynchronization therapy: a practical guide. Eur Heart J 2017 May;38:1463–1472. doi: 10.1093/eurheartj/ehw270 27371720

25. Caritá P, Corrado E, Pontone G, Curnis A, Bontempi L, Novo G et al. Non-responders to cardiac resynchronization therapy: Insights from multimodality imaging and electrocadiography. A brief review. International Journal of Cardiology, 225,402–407. doi: 10.1016/j.ijcard.2016.09.037 27776243

26. Vetta F, Vetta G, Bracchitta S, Mignano M, Mattatelli A. Cardiac resynchronization therapy in the elderly. How much is it safe and beneficial? Monaldi Arch Chest Dis 2019 Mar;89:41–43.

27. Adelstein EC, Liu J, Jain S, Schwartzman D, Althouse AD, Wang NC, et al. Clinical Outcomes in cardiac resynchronization therapy-defibrilaltor recipients 80 years of age and older. Europace, 18(3), 420–427. doi: 10.1093/europace/euv222 26487669

28. Killu AM, Wu JH, Friedman PA, Shen WK, Webster TL, Brooke KL, et al. Outcomes of cardiac resynchronization therapy in the elderly. Pacing Clin Electrophysiol 2013 Jun;36:664–672. doi: 10.1111/pace.12048 23252710

29. Esmaiel A, Hassan J, Blenkhorn F, Mardigyan V. The Use of Ultrasound to Improve Axillary Vein Access and Minimize Complications during Pacemaker Implantation. Pacing Clin Electrophysiol 2016 May;39:478–482. doi: 10.1111/pace.12833 26880272

30. Migliore F, Curnis A, Bertaglia E. Axillary vein technique for pacemaker and implantable defibrillator leads implantation: a safe and alternative approach? J Cardiovasc Med (Hagerstown) 2016 Apr;17:309–313.