Cardiac Resynchronization Therapy in Inotrope-Dependent Heart Failure Patients: A Systematic Review and Meta-Analysis
Gabriel A Hernandez1, Vanessa Blumer2, Luis Arcay2
1Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Cardiac resynchronization therapy (CRT) can help inotrope-dependent heart failure patients. This therapy allows many patients to stop inotropic support and improves survival rates.
Area of Science:
- Cardiology
- Heart Failure Management
- Cardiac Pacing
Background:
- Cardiac resynchronization therapy (CRT) is established for heart failure (HF) patients with systolic dysfunction and conduction delays.
- Its efficacy in patients requiring inotropic support remains unclear.
Purpose of the Study:
- To evaluate the outcomes of CRT in patients with heart failure (HF) who are dependent on inotropic support.
- To determine the viability of CRT as a treatment option for this patient population.
Main Methods:
- Systematic literature search of Medline, Embase, Scopus, and Cochrane Library up to March 2017.
- Analysis of 8 studies involving 151 inotrope-dependent HF patients.
- Patients predominantly had advanced HF (NYHA class IV), severe systolic dysfunction (LVEF <30%), and prolonged QRS duration (>130 ms).
Main Results:
- A significant majority (93%) of patients were successfully weaned from inotropic support post-CRT.
- The overall 12-month survival rate was 69% in this cohort.
- CRT demonstrated a positive impact on inotrope-dependent HF patients.
Conclusions:
- Rescue CRT is a viable therapeutic option for inotrope-dependent heart failure patients.
- CRT can facilitate weaning from inotropic therapy, enhance quality of life, and reduce mortality.
- CRT may serve as a crucial bridge to advanced therapies like cardiac transplantation or LVAD.
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 a left ventricular ejection fraction <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.
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