Benefits of cardiac resynchronization therapy persist at advanced age

Abstract

Objective: To assess reverse left ventricular remodeling, improvement in functional capacity and clinical outcome, in older CRT patients typically not included in randomized clinical trials.

Methods: Consecutive CRT patients (n = 201) who were implanted between October 2008 and April 2011 including optimization afterwards in a dedicated clinic, were stratified into 3 groups according to age: < 70 years (n = 72); 70 - 79 years (n = 89); and 80 years (n = 40). Effects of CRT on left ventricular remodeling (i.e. change in left ventricular end-diastolic and end-systolic diameter), functional capacity and clinical outcome were assessed during follow-up.

Results: Change in left ventricular end-diastolic and end-systolic diameter (P-value = 0.092 and 0.660, respectively, between groups), improvement in New York Heart Association functional class (P-value = 0.597 between groups) and increase of maximal aerobic capacity (P-value = 0.350 between groups), were similar in all groups 6 months after implantation. During mean follow-up of 15 months, 21 patients died and 50 were admitted for heart failure. Time to all-cause mortality and time to first heart failure admission were independent from age (Figure). Progressive pump failure was the major cause of death (57 %), while malignant ventricular arrhythmias were rare (7 %).

Conclusions: Reverse ventricular remodeling and functional capacity improvement after CRT are sustained at advanced age. Moreover, clinical outcome (heart failure events and all-cause mortality) were similar, irrespective of age, in a context of maximized optimization including optimal medical therapy.