Cardiac resynchronization therapy in patients with end-stage inotrope-dependent class IV heart failure

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Management

Background:

• Cardiac resynchronization therapy (CRT) is established for drug-refractory heart failure (HF) with left ventricular (LV) dyssynchrony.
• Its efficacy in advanced, inotrope-dependent HF (NYHA class IV) remains less defined.

Purpose of the Study:

• To evaluate the clinical outcomes and LV function changes in inotrope-dependent NYHA class IV HF patients receiving CRT.
• To assess the feasibility of weaning inotropic support post-CRT.

Main Methods:

• Ten patients with inotrope-dependent NYHA class IV HF received CRT implantable cardioverter-defibrillator devices.
• Patients had LV dyssynchrony indicated by ECG (QRS duration ≥150 ms) or echocardiography.
• Intravenous inotropic support (dobutamine or milrinone) was administered before and during CRT.

Main Results:

• All patients survived long-term follow-up (mean 1,088 days); three received cardiac transplants.
• Nine patients improved to NYHA class II/III, and nine were weaned off inotropic support.
• LV ejection fraction significantly increased (23.5% to 32.0%), and LV end-systolic volume decreased.

Conclusions:

• CRT can lead to favorable long-term clinical benefits and improved LV function in end-stage, inotrope-dependent NYHA class IV HF patients with LV dyssynchrony.
• CRT may facilitate discontinuation of intravenous inotropic therapy in this challenging patient population.