Stefano Fumagalli1, Paolo Pieragnoli2, Giuseppe Ricciardi2, Giuseppe Mascia2, Franco Mascia3, Federica Michelotti2, Giosuè Mascioli4, Matteo Beltrami2, Margherita Padeletti5, Martina Nesti2, Niccolò Marchionni6, Luigi Padeletti7. 1. 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. 2. 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. 3. Emergency Cardiology Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy. 4. Department of Arrhythmology, Cliniche Humanitas Gavazzeni, Bergamo, Italy. 5. Department of Cardiovascular Diseases, University of Siena, Siena, Italy. 6. 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. 7. 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.
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.
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: Nikolaos Dagres; Tze-Fan Chao; Guilherme Fenelon; Luis Aguinaga; Daniel Benhayon; Emelia J Benjamin; T Jared Bunch; Lin Yee Chen; Shih-Ann Chen; Francisco Darrieux; Angelo de Paola; Laurent Fauchier; Andreas Goette; Jonathan Kalman; Lalit Kalra; Young-Hoon Kim; Deirdre A Lane; Gregory Y H Lip; Steven A Lubitz; Manlio F Márquez; Tatjana Potpara; Domingo Luis Pozzer; Jeremy N Ruskin; Irina Savelieva; Wee Siong Teo; Hung-Fat Tse; Atul Verma; Shu Zhang; Mina K Chung; William-Fernando Bautista-Vargas; Chern-En Chiang; Alejandro Cuesta; Gheorghe-Andrei Dan; David S Frankel; Yutao Guo; Robert Hatala; Young Soo Lee; Yuji Murakawa; Cara N Pellegrini; Claudio Pinho; David J Milan; Daniel P Morin; Elenir Nadalin; George Ntaios; Mukund A Prabhu; Marco Proietti; Lena Rivard; Mariana Valentino; Alena Shantsila Journal: J Arrhythm Date: 2018-03-23
Authors: Fang Qin Goh; William K F Kong; Raymond C C Wong; Yao Feng Chong; Nicholas W S Chew; Tiong-Cheng Yeo; Vijay Kumar Sharma; Kian Keong Poh; Ching-Hui Sia Journal: Biology (Basel) Date: 2022-01-23
Authors: Claudia K Suemoto; Laura E Gibbons; Evan L Thacker; Jonathan D Jackson; Claudia L Satizabal; Brianne M Bettcher; Lenore Launer; Caroline Phillips; Lon R White; Melinda C Power Journal: PLoS One Date: 2020-02-25 Impact factor: 3.240