Cardiac Resynchronization Therapy in Inotrope-Dependent Heart Failure Patients: A Systematic Review and Meta-Analysis

Gabriel A. Hernandez, Vanessa Blumer, Luis Arcay, Jorge Monge, Juan Viles Gonzalez, Jo Ann Lindenfeld, Jeffrey Goldberger, Sandra Chaparro

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)734-742
Number of pages9
JournalJACC: Heart Failure
Volume6
Issue number9
DOIs
StatePublished - Sep 1 2018

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Cardiac Resynchronization Therapy
Meta-Analysis
Heart Failure
Systolic Heart Failure
Confidence Intervals
Heart-Assist Devices
Heart Transplantation
Therapeutics
Stroke Volume
Libraries
Survival Rate
Quality of Life
Outcome Assessment (Health Care)

Keywords

  • cardiac resynchronization therapy
  • heart failure
  • inotropes
  • New York Heart Association functional class IV

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac Resynchronization Therapy in Inotrope-Dependent Heart Failure Patients : A Systematic Review and Meta-Analysis. / Hernandez, Gabriel A.; Blumer, Vanessa; Arcay, Luis; Monge, Jorge; Viles Gonzalez, Juan; Lindenfeld, Jo Ann; Goldberger, Jeffrey; Chaparro, Sandra.

In: JACC: Heart Failure, Vol. 6, No. 9, 01.09.2018, p. 734-742.

Research output: Contribution to journalArticle

Hernandez, Gabriel A. ; Blumer, Vanessa ; Arcay, Luis ; Monge, Jorge ; Viles Gonzalez, Juan ; Lindenfeld, Jo Ann ; Goldberger, Jeffrey ; Chaparro, Sandra. / Cardiac Resynchronization Therapy in Inotrope-Dependent Heart Failure Patients : A Systematic Review and Meta-Analysis. In: JACC: Heart Failure. 2018 ; Vol. 6, No. 9. pp. 734-742.
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AB - 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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