Division of Electrophysiology, University of Pittsburgh Medical Center, Cardiovascular Institute, Pittsburgh, Pennsylvania 15213, USA.
Clin Cardiol. 2010 Jul;33(7):E1-5. doi: 10.1002/clc.20500.
Optimal pharmacologic therapy (OPT) is considered a prerequisite to consideration for cardiac resynchronization therapy (CRT).
Medications such as beta-blockers (BB) with demonstrated benefit in heart failure (HF) are being under utilized in patients receiving CRT.
Consecutive patients receiving a CRT-capable defibrillator in 2004 at a tertiary care center for standard indications were studied. Clinical data and medications upon hospital discharge were recorded. Patients were followed for endpoints of death or transplantation.
Of 177 patients receiving a CRT device, 129 (73%) received BB therapy (group 1). Of the 48 patients not on BBs (group 2), relative contraindications were documented in 21 (allergy in 3, hypotension or inotrope-dependent HF in 4, chronic obstructive pulmonary disease [COPD] in 6, and amiodarone therapy in 8). The remaining 27 patients (group 3) did not receive BB therapy despite absence of documented justification. Compared to group 1, group 3 patients were similar in terms of clinical characteristics and angiotensin-converting enzyme inhibitor (ACEI) use, but were less likely to be on statin therapy. Patients were followed for a mean of 19.9 +/- 9.2 mo. After adjusting for age, QRS duration, creatinine, left ventricular ejection fraction (LVEF), statin use, and presence of ischemic HF etiology, patients not receiving BB therapy in the absence of contraindication had increased risk of death or transplantation (odds ratio [OR]: 3.1, p = 0.043).
Absence of BB therapy appears to be independently associated with poor outcome in CRT recipients. These results suggest that a crucial component of OPT may be underutilized in a population of HF patients receiving CRT.
优化药物治疗（OPT）被认为是考虑心脏再同步治疗（CRT）的前提。
在接受 CRT 的患者中，β受体阻滞剂（BB）等已证明对心力衰竭（HF）有益的药物并未得到充分利用。
对 2004 年在一家三级保健中心因标准适应证接受 CRT 兼容除颤器的连续患者进行了研究。记录了出院时的临床数据和药物治疗情况。患者被随访终点为死亡或移植。
在 177 例接受 CRT 设备的患者中，129 例（73%）接受了 BB 治疗（组 1）。在未接受 BB 治疗的 48 例患者中（组 2），记录了相对禁忌证 21 例（过敏 3 例，低血压或正性肌力药依赖型 HF 4 例，慢性阻塞性肺疾病[COPD] 6 例，胺碘酮治疗 8 例）。其余 27 例患者（组 3）尽管没有记录的理由，但未接受 BB 治疗。与组 1 相比，组 3 患者在临床特征和血管紧张素转换酶抑制剂（ACEI）使用方面相似，但他汀类药物治疗的可能性较小。患者平均随访 19.9 +/- 9.2 个月。在校正年龄、QRS 持续时间、肌酐、左心室射血分数（LVEF）、他汀类药物使用和缺血性 HF 病因存在后，在无禁忌证的情况下未接受 BB 治疗的患者死亡或移植的风险增加（比值比[OR]：3.1，p = 0.043）。
BB 治疗的缺失似乎与 CRT 受者的不良预后独立相关。这些结果表明，在接受 CRT 的 HF 患者中，OPT 的一个关键组成部分可能未得到充分利用。
