- 作者：Ikutaro Nakajima ; Takashi Noda ; Hideaki Kanzaki ; Kohei Ishibashi ; Koji Miyamoto ; Yuko Yamada ; Hideo Okamura ; Kazuhiro Satomi ; Takeshi Aiba ; Shiro Kamakura ; Toshihisa Anzai ; Masaharu Ishihara ; Satoshi Yasuda ; Hisao Ogawa ; Wataru Shimizu
- 关键词：Cardiac resynchronization therapy ; Inotrope-dependent heart failure ; Survival
- 刊名：Journal of Arrhythmia
- 出版年：December, 2013
- 年：2013
- 卷：29
- 期：6
- 页码：342-346
- 全文大小：451 K
Background
Cardiac resynchronization therapy (CRT) has been widely used for the treatment of refractory heart failure (HF). However, the efficacy of CRT is not well established in class IV HF patients on inotropic support.Methods
Twenty-six patients (age 55卤18 years, 73% men) with inotrope-dependent HF were reviewed to evaluate the effectiveness of CRT in class IV HF patients on inotropic support.
Results
Intravenous inotropic therapy was administered for 72卤56 days before CRT and consisted of dobutamine (n=24; 3.0卤1.2 渭g kg鈭? min鈭?), dopamine (n=2; 4.5卤2.1 渭g kg鈭? min鈭?), and/or milrinone (n=16; 0.12卤0.09 渭g kg鈭? min鈭?). CRT did not produce significant reverse remodeling in eligible patients (left ventricular ejection fraction 23卤7% to 25卤9%; p=0.23, left ventricular end-diastolic diameter 70卤9 mm to 68卤9 mm; p=0.14). After CRT device implantation, 13 (50%) patients experienced 1 or more episodes of ventricular tachyarrhythmia or sudden cardiac death. Twenty (77%) patients survived to hospital discharge with weaning from inotropic support (70卤70 days after CRT implantation). The 1-year survival rate was 81%. However, data from long-term follow-up showed that 68% of the study patients who attained survival discharge had an HF hospitalization event within the follow-up period.
Conclusion
CRT did not result in significant reverse remodeling in patients with inotrope-dependent class IV end-stage HF. However, it contributed to dramatically improve the cardiovascular outcomes at least in the short-term period in some patients.