HIỆU QUẢ NGẮN HẠN CỦA LIỆU PHÁP TÁI ĐỒNG BỘ TIM Ở BỆNH NHÂN CAO TUỔI CÓ SUY TIM PHÂN SUẤT TỐNG MÁU GIẢM

Abstract

Background: Heart failure is a clinical syndrome presenting with specific symptoms and signs, as a result of various structural and functional abnormalities. In this group of patients with heart failure, cardiac dyssynchrony was an independent predictor of overall death. The resynchronization treatment helps to reduced the mortality rate; However, the effectiveness of this method was mainly investigated in the general heart failure population in Vietnam. Evidence on efficacy and safety in elderly patients is still limited, with the proportion of elderly in cardiac resynchronization studies being only 15-37.5%. Cardiac resynchronization therapy has been carried out since 2008 at Cho Ray hospital, with a large numbert of patients and most of which are elderly. For the above reasons, we conducted a this study in order to access the efficacy and the safety of this treatment in such fagile group of patients, the elderly. Objective: To evaluate the effectiveness and determine the complication rate during 1 month after treatment with cardiac resynchronization therapy in elderly patients with heart failure and reduced ejection fraction at Cho Ray Hospital. Subjects and methods: The study included patients over 60 years old who had been diagnosed with heart failure with reduced ejection fraction according to diagnostic criteria of ESC 2016, with EF≤ 35% and had been receving optimal medical therapy for at least three months. These patients had indication for resynchronization therapy and were implanted with CRT devices at Cho Ray hospital from March 2017 to June 2022. We conducted a cross-sectional study with longitudinal follow-up up to 1 month after cardiac resynchronization therapy and documeted complications as well as response rates based on the patient's clinical and echocardiographic improvement. Results: This study enrolled 100 elderly patients with heart failure with reduced ejection fraction with an average age of 70.3 ± 7.6 and 45% of them are male. Evaluation was based on composite criteria of both clinical symptom response (NYHA class of heart failure, 6-minute walk test) and echocardiographic parameter response (left ventricular ejection fraction, chamber sizes), the response rate to cardiac resynchronization therapy in the elderly with heart failure with reduced ejection fraction at 1 month was 49%. The complication rate for 1 month after cardiac resynchronization was 10% with the most common complications including hematoma (4%), disloedgement of the left ventricular pacing lead (3%), increased pacing threshold (2%), and mistaken shock (1%). However, the complications were all successfully managed conservatively. Conclusion: Cardiac resynchronization therapy can be used in the treatment of elderly patients with heart failure with reduced ejection fraction when the patients are correctly indicated. This treatment could benifit in obtaining early response to improve symptoms of heart failure with a 1-month complication rate of 10%.