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Advanced therapeutic interventions in elderly heart failure: outcomes of cardiac resynchronization therapy
Session:
SESSÃO DE POSTERS 10 - GERIATRIA CARDIOVASCULAR: MOSTRA-ME OS DADOS!
Speaker:
Ana Rita Teixeira
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Rita Teixeira; Julien Lopes; André Paulo Ferreira; Madalena Coutinho Cruz; Guilherme Portugal; Ana Lousinha; Pedro Silva Cunha; Tânia Mano; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Introduction:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> The increasing prevalence of heart failure (HF) among the aging population has prompted questions about the suitability of advanced therapeutic interventions, such as cardiac resynchronization therapy (CRT), in elderly individuals. This study aims to assess the clinical and echocardiographic outcomes over a 6-month period in patients aged 75 years and older.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> A single-center retrospective analysis was conducted on a cohort of patients who underwent successful CRT device implantation between 2011 and 2016. Clinical status, echocardiographic parameters and cardiopulmonary exercise testing data were assessed both before and 6 months after CRT implantation. Follow-up data included changes in left ventricular ejection fraction (LVEF) and LV end-systolic volume (LVESV), New York Heart Association (NYHA) functional class, and the incidence of major adverse cardiovascular events (MACE) post-CRT. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Results</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: The study involved 204 HF patients with a mean age 70±10 years, of whom 64.7% had left bundle branch block and a baseline QRS of 151±21ms. Atrial fibrillation was present in 74 patients, and a defibrillator was added in 79.9% of cases. Initial echocardiography indicated severe systolic dysfunction, with a mean LVEF of 26±7%, and severe LV dilation (end-systolic and end-diastolic volumes, 151mm and 204mm, respectively). Of these patients, 70 HF were ≥ 75 years old. The older group showed a higher prevalence of hypertension (p=0.033) and a more frequent use of CRT-P instead of defibrillator (p<0.001). Echocardiographic LVEF was higher in older HF patients (28±7 vs 25±7%, p=0.014) while peak VO<sub>2</sub> was lower (14.1±3.8 vs 17±4.3, p=0.012). No significant differences were observed between groups regarding sex, other cardiovascular risk factors or comorbidities and NYHA class (p=ns). NYHA class improvement was similar between groups. Significant improvements in elderly patients were observed in LVEF (p=0.034) and a reduction in LVESV (p<0.001) which did not show significant differences between younger patients. At the 6-month follow-up, older patients had more heart failure hospitalizations (p=0.022), although death, arrhythmias and ischemic events were comparable between both groups.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></strong> <span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">In our population, CRT demonstrated effectiveness in LV remodeling among elderly heart failure patients. Despite favorable outcomes and a similar improvement in NYHA class between groups, elderly patients experienced more HF hospitalizations at the 6-month follow-up. The results suggest that advanced age alone should not limit CRT implantation in well-selected patients. </span></span></span></span></p>
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