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 690 pg/mL)...

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Bibliographic Details
Published in:Journal of cardiac failure 2015-06, Vol.21 (6), p.535-538
Main Authors: Imamura, Teruhiko, MD, PhD, Kinugawa, Koichiro, MD, PhD, Nitta, Daisuke, MD, Hatano, Masaru, MD, Komuro, Issei, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Cardiac Resynchronization Therapy - adverse effects
Cardiac Resynchronization Therapy - methods
Cardiotonic Agents - therapeutic use
Cardiovascular
catecholamine
Defibrillators, Implantable
Echocardiography
Female
Heart Failure - diagnosis
Heart Failure - mortality
Heart Failure - physiopathology
Heart Failure - therapy
Humans
INTERMACS
Japan
Male
Middle Aged
Natriuretic Peptide, Brain - analysis
Prognosis
reverse remodeling
Severity of Illness Index
Survival Analysis
Treatment Outcome
ventricular assist device
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Summary: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 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.
ISSN:1071-9164
1532-8414
DOI:10.1016/j.cardfail.2015.04.009