Should cardiac resynchronization therapy be a rescue therapy for inotrope-dependent patients with advanced heart failure?

Abstract

BACKGROUND:

Although the "off-label usage" of cardiac resynchronization therapy with defibrillator (CRT-D) has spread recently in advanced heart failure (HF) patients in the real-world practice, its clinical effect remained uncertain.

METHODS AND RESULTS:

A total of 84 in-hospital <65-year old patients with advanced HF undergoing CRT-D were enrolled. Seventeen patients (20%) had been dependent on inotropes at the time of CRT-D implantation, and 17 suffered cardiac death within a year. Both inotrope dependence and elevated plasma levels of B-type natriuretic peptide (BNP) (>690 pg/mL) at the time of CRT-D implantation were independent predictors of cardiac death within a year by Cox regression analyses (P < 0.05 for both). These 2 parameters could significantly stratify 1-year ventricular assist device (VAD)-free survival: inotrope-free low (1) or high BNP (2), or inotrope-dependent low (3) or high BNP groups (4) (98, 77, 57, and 17%, respectively, P < 0.001). In contrast, there were no significant differences in actual 1-year survival among the four groups.

CONCLUSION:

Patients dependent on inotropes sometimes receive CRT-D therapy as the last treatment resort in clinical practice, but LVAD implantation should be considered instead of CRT-D in advanced HF patients because of their poor prognosis with CRT-D therapy.

• Authors: Teruhiko Imamura, Koichiro Kinugawa, Daisuke Nitta, Masaru Hatano, Issei Komuro
• Journal: Journal of cardiac failure (J Card Fail) Vol. 21 Issue 6 Pg. 535-8 (Jun 2015) ISSN: 1532-8414 [Electronic] United States
• PMID: 25930086 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Cardiotonic Agents
• Natriuretic Peptide, Brain

Topics

• Adult
• Cardiac Resynchronization Therapy (adverse effects, methods)
• Cardiotonic Agents (therapeutic use)
• Defibrillators, Implantable
• Echocardiography
• Female
• Heart Failure (diagnosis, mortality, physiopathology, therapy)
• Humans
• Japan
• Male
• Middle Aged
• Natriuretic Peptide, Brain (analysis)
• Prognosis
• Severity of Illness Index
• Survival Analysis
• Treatment Outcome