Author + information
- Received September 25, 2017
- Revision received February 20, 2018
- Accepted February 27, 2018
- Published online August 9, 2018.
- Gabriel A. Hernandez, MDa,∗ (, )
- Vanessa Blumer, MDb,
- Luis Arcay, MDb,
- Jorge Monge, MDb,
- Juan F. Viles-Gonzalez, MDc,
- JoAnn Lindenfeld, MDa,
- Jeffrey J. Goldberger, MDd and
- Sandra Chaparro, MDd
- aDivision of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
- bInternal Medicine, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
- cCardiovascular Division, Department of Medicine, Tulane University, New Orleans, Louisiana
- dCardiovascular Division, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
- ↵∗Address for correspondence:
Dr. Gabriel A. Hernandez, Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East Office 5037, Nashville, Tennessee 37232.
Objectives The purpose of this study was to evaluate outcomes after cardiac resynchronization therapy (CRT) in inotrope-dependent patients with heart failure (HF) to ascertain the viability of CRT in these patients.
Background During the last decade, significant numbers of trials have demonstrated the beneficial effect of CRT in the treatment of patients with HF and systolic dysfunction, prolonged QRS complex duration, and New York Heart Association functional class III or IV. However, it is currently undetermined whether CRT may benefit patients who require inotropic support.
Methods The authors systematically searched Medline, Embase, Scopus, and the Cochrane Library through March 2017 for studies evaluating outcomes after CRT in inotrope-dependent patients with HF. The study analyzed 8 studies including 151 patients. Most of the patients were in New York Heart Association functional class IV (80.1%), and all had severe systolic HF, with left ventricular ejection fraction less than 30% and a significant intraventricular conduction delay in their surface electrocardiogram (QRS complex duration >130 ms).
Results The pooled analysis demonstrated that 93% of the reported patients (95% confidence interval: 86% to 100%) were weaned from inotropic support after CRT, and the overall 12-month survival rate was 69% (95% confidence interval: 56% to 83%).
Conclusions This study suggests that rescue CRT may be considered a viable therapeutic option in inotrope-dependent patients with HF. In these patients, rescue CRT may allow them to be weaned from inotropic therapy, improve their quality of life, and decrease the rate of mortality; furthermore, rescue CRT may serve as a possible bridge to cardiac transplantation or left ventricular assist device therapy.
- cardiac resynchronization therapy
- heart failure
- New York Heart Association functional class IV
Dr. Lindenfeld is a consultant for Boston Scientific, Novartis, Edwards, Abbott, Relypsa, Resmed, and VWave; and has received grants from the National Institutes of Health, the American Heart Association, Novartis, and AstraZeneca. Dr. Goldberger is the Director of the Path to Improved Risk Stratification, NFP, a not-for-profit organization on risk stratification for sudden cardiac death that has received unrestricted educational grants from Boston Scientific, Gilead, GE Medical, Medtronic, and St. Jude. Dr. Chaparro has received research grants from Abbott and Medtronic; and is a consultant for Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Drs. Hernandez and Blumer contributed equally to this work and are joint first authors.
John R. Teerlink, MD, served as Guest Editor for this paper.
- Received September 25, 2017.
- Revision received February 20, 2018.
- Accepted February 27, 2018.
- 2018 American College of Cardiology Foundation
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