Grosu Aurelia, Senni Michele, Iacovoni Attilio, Gori Mauro, Cantù Francesco, Bisetti Silvia, De Santo Tiziana, De Luca Alessandro, Gavazzi Antonello
Cardiovascular Department, Riuniti Hospital, Bergamo, Italy.
Acta Cardiol. 2011 Oct;66(5):573-80. doi: 10.1080/ac.66.5.2131081.
Cardiac resynchronization therapy (CRT), combined with optimal medical therapy (OMT), is an established treatment for patients with advanced chronic heart failure (ACHF). In ACHF, carvedilol at the dose used in clinical trials, reduces morbidity and mortality. However, patients often do not tolerate the drug at the targeted dosage. The aim of the CARIBE-HF prospective observational study was to investigate the role of CRT in the implementation of carvedilol therapy in patients with ACHF.
One hundred and six patients (aged 65 12 [mean +/- SD] years) with ACHF were enrolled and treated with OMT, in which carvedilol was titrated up to the maximal dose (phase 1). Subsequently, patients with left ventricular (LV) ejection fraction < or = 35%, NYHA class III-IV and QRS interval > or =120 msec were assigned to CRT. Both CRT and NO-CRT patients underwent a long-term follow-up of 7 years (1193.98 +/- 924 days), while efforts to up titrate the carvedilol dose were continued during the second phase (471 + 310 days). Phase 1 was completed by 84 patients (79%), and 15 (18%) underwent CRT. The mean carvedilol dose in the CRT group was 19.0 +/- 17.8 mg, against 32.7 +/- 19.1 mg in the remaining 69 patients (P = 0.018). At the end of phase 2, CRT patients presented a significantly greater variation of increasing in the carvedilol dose than NO-CRT patients (+20.0 +/- 19.8 mg vs. -0.3 +/- 20.5 mg; P = 0.015), a greater NYHA class reduction (-0.8 +/- 0.6 vs. -0.2 +/- 0.7; P = 0.011), and a greater increase in LV ejection fraction (10.8 +/- 9 vs. 3.1 +/- 6.1; P = 0.018).
The data from the CARIBE study suggest that, in ACHF, CRT may be effective in enabling the target dose of carvedilol to be reached. The significant improvement seen in LV function was probably due to a synergistic effect of CRT and carvedilol. During the extended follow-up (mean 1193.98 +/- 924 days) the mean dosage of carvedilol in the CRT group was significantly higher (P < 0.02).
心脏再同步治疗（CRT）联合最佳药物治疗（OMT）是晚期慢性心力衰竭（ACHF）患者的既定治疗方法。在ACHF中，临床试验中使用的剂量的卡维地洛可降低发病率和死亡率。然而，患者通常不能耐受目标剂量的药物。CARIBE-HF前瞻性观察性研究的目的是调查CRT在ACHF患者卡维地洛治疗实施中的作用。
106例ACHF患者（年龄65±12[平均±标准差]岁）入组并接受OMT治疗，其中卡维地洛滴定至最大剂量（第1阶段）。随后，左心室（LV）射血分数≤35%、纽约心脏协会（NYHA）心功能分级III-IV级且QRS间期≥120毫秒的患者被分配接受CRT。CRT组和非CRT组患者均接受了7年（1193.98±924天）的长期随访，同时在第二阶段（471±310天）继续努力上调卡维地洛剂量。84例患者（79%）完成了第1阶段，15例（18%）接受了CRT。CRT组卡维地洛的平均剂量为19.0±17.8毫克，其余69例患者为32.7±19.1毫克（P=0.018）。在第2阶段结束时，CRT组患者卡维地洛剂量增加的变化明显大于非CRT组患者（+20.0±19.8毫克对-0.3±20.5毫克；P=0.015），NYHA分级降低幅度更大（-0.8±0.6对-0.2±0.7；P=0.011），LV射血分数增加幅度更大（10.8±9对3.1±6.1；P=0.018）。
CARIBE研究的数据表明，在ACHF中，CRT可能有效地使卡维地洛达到目标剂量。LV功能的显著改善可能是由于CRT和卡维地洛的协同作用。在延长随访期间（平均1193.98±924天），CRT组卡维地洛的平均剂量显著更高（P<0.02）。
