AIMS: Age is not a contraindication to cardiac resynchronization therapy (CRT), but the prevalence and prognostic impact of QRS prolongation with intraventricular conduction delay (IVCD) and left bundle branch block (LBBB), as well as CRT utilization, may differ with age. We tested the hypotheses that in the elderly: (i) IVCD and LBBB are more prevalent, (ii) IVCD and LBBB are more harmful, and (iii) CRT is underutilized. METHODS AND RESULTS: We studied 14 713 patients with ejection fraction ≤39% in the Swedish Heart Failure Registry and divided into age groups ≤65 years, 66-80 years and >80 years. Among 13 782 patients without CRT, IVCD was present in the three age groups in 11% vs. 15% vs. 19% and LBBB was present in 20% vs. 27% vs. 28%, respectively, (P < 0.001). The multivariable hazard ratio (HR) for all-cause mortality over a median (interquartile range) follow-up of 29 (12-53) months for IVCD vs. narrow QRS was 1.31 (1.06-1.63, P = 0.013) in the ≤65 year group, 1.32 (1.17-1.47, P < 0.001) in the 66-80 year group, and 1.26 (1.21-1.41, p < 0.001) in the >80 year group. For LBBB vs. narrow QRS it was 1.29 (1.07-1.56, P = 0.009), 1.17 (1.06-1.30, P = 0.002), and 1.10 (0.99-1.22, P = 0.091), respectively. The adjusted P for interaction between age and QRS morphology was 0.664. In the three age groups, CRT was present in 6% vs. 8% vs. 4% and absent but with indication in 23% vs. 32% vs. 37%, respectively (P < 0.001). CONCLUSIONS: Both IVCD and LBBB were more common with increasing age and were similarly strong independent predictors of mortality and in all ages. The underutilization of CRT was worse with increasing age.
AIMS: Age is not a contraindication to cardiac resynchronization therapy (CRT), but the prevalence and prognostic impact of QRS prolongation with intraventricular conduction delay (IVCD) and left bundle branch block (LBBB), as well as CRT utilization, may differ with age. We tested the hypotheses that in the elderly: (i) IVCD and LBBB are more prevalent, (ii) IVCD and LBBB are more harmful, and (iii) CRT is underutilized. METHODS AND RESULTS: We studied 14 713 patients with ejection fraction ≤39% in the Swedish Heart Failure Registry and divided into age groups ≤65 years, 66-80 years and >80 years. Among 13 782 patients without CRT, IVCD was present in the three age groups in 11% vs. 15% vs. 19% and LBBB was present in 20% vs. 27% vs. 28%, respectively, (P < 0.001). The multivariable hazard ratio (HR) for all-cause mortality over a median (interquartile range) follow-up of 29 (12-53) months for IVCD vs. narrow QRS was 1.31 (1.06-1.63, P = 0.013) in the ≤65 year group, 1.32 (1.17-1.47, P < 0.001) in the 66-80 year group, and 1.26 (1.21-1.41, p < 0.001) in the >80 year group. For LBBB vs. narrow QRS it was 1.29 (1.07-1.56, P = 0.009), 1.17 (1.06-1.30, P = 0.002), and 1.10 (0.99-1.22, P = 0.091), respectively. The adjusted P for interaction between age and QRS morphology was 0.664. In the three age groups, CRT was present in 6% vs. 8% vs. 4% and absent but with indication in 23% vs. 32% vs. 37%, respectively (P < 0.001). CONCLUSIONS: Both IVCD and LBBB were more common with increasing age and were similarly strong independent predictors of mortality and in all ages. The underutilization of CRT was worse with increasing age.
Authors: Jani Rankinen; Petri Haataja; Leo-Pekka Lyytikäinen; Heini Huhtala; Terho Lehtimäki; Mika Kähönen; Markku Eskola; Andrés Ricardo Pérez-Riera; Antti Jula; Teemu Niiranen; Kjell Nikus; Jussi Hernesniemi Journal: Int J Cardiol Heart Vasc Date: 2020-09-25
Authors: Jesse F Veenis; Hans-Peter Brunner-La Rocca; Gerard Cm Linssen; Peter R Geerlings; Marco Wf Van Gent; Ismail Aksoy; Liane Oosterom; Arno Hm Moons; Arno W Hoes; Jasper J Brugts Journal: Eur J Prev Cardiol Date: 2019-03-13 Impact factor: 7.804
Authors: Diana Gurzău; Alexandra Dădârlat-Pop; Bogdan Caloian; Gabriel Cismaru; Horaţiu Comşa; Raluca Tomoaia; Dumitru Zdrenghea; Dana Pop Journal: J Clin Med Date: 2021-05-25 Impact factor: 4.241