Kachboura S, Ben Halima A, Ibn Elhadj Z, Marrakchi S, Chrigui R, Kammoun I, Chine S, Lefi A
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia.
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia.
Ann Cardiol Angeiol (Paris). 2014 Feb;63(1):17-22. doi: 10.1016/j.ancard.2013.02.002. Epub 2013 Mar 13.
Cardiac resynchronization therapy (CRT) is recommended for selected patients with advanced heart failure (HF) despite optimal medical treatment. However, the doses of pharmaceuticals in this population are often limited by adverse effects. We compared the drug regimens of 21 patients before and 6 months after they underwent the implantation CRT systems.
We studied 17 men and four women (mean age=63.4 ± 11 years) presenting in New York Heart Association HF classes III-IV, and with a left ventricular ejection fraction (LVEF) ≤ 35% and cardiac dyssynchrony, who underwent implantation of CRT systems.
At baseline, 52% of patients were treated with β-adrenergic blockers (β-B), though in optimal doses in only 19%. The introduction of (β-B) was complicated by cardiogenic shock in three patients. At baseline, all patients were treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), of whom 76% received optimal doses. After 6 months of CRT, β-B were administered to 76% of patients, in optimaklon ACE or ARB but 75% of them were receiving maximal doses. After 6 months of CRT, β blockers have been introduced in 72% of patients and maximal doses have been achieved in 60% of them. Maximal doses of ACE or ARB were reached in 95% of the study population. We noticed that systolic blood pressure was higher after implantation. There was also a significant improvement in functional status and left ventricular ejection fraction compared to baseline.
CRT is an efficacious adjunctive device therapy to standard medical therapy for patients with heart failure and cardiac dyssynchrony. Its benefits are in addition to those afforded by standard pharmacological therapy. Achieving maximal doses of medical treatment and the possibility of introducing β blockers after CRT prove that CRT and pharmacological treatment are complementary strategies and should not be considered as competitive.
对于经最佳药物治疗后仍患有晚期心力衰竭（HF）的特定患者，推荐进行心脏再同步治疗（CRT）。然而，该人群中的药物剂量常常受到不良反应的限制。我们比较了21例患者在植入CRT系统前后的药物治疗方案。
我们研究了17例男性和4例女性（平均年龄 = 63.4 ± 11岁），这些患者纽约心脏协会心功能分级为III - IV级，左心室射血分数（LVEF）≤ 35%且存在心脏不同步，他们接受了CRT系统植入。
基线时，52%的患者接受β - 肾上腺素能阻滞剂（β - B）治疗，但仅19%达到最佳剂量。3例患者因使用β - B引发心源性休克。基线时，所有患者均接受血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB）治疗，其中76%接受最佳剂量。CRT治疗6个月后，76%的患者使用β - B，其中75%达到最大剂量。CRT治疗6个月后，72%的患者开始使用β受体阻滞剂，其中60%达到最大剂量。95%的研究人群达到了ACE或ARB的最大剂量。我们注意到植入后收缩压更高。与基线相比，功能状态和左心室射血分数也有显著改善。
对于心力衰竭和心脏不同步的患者，CRT是标准药物治疗的有效辅助器械治疗。其益处是标准药物治疗之外的。达到药物治疗的最大剂量以及在CRT后使用β受体阻滞剂的可能性证明，CRT和药物治疗是互补策略，不应被视为相互竞争。
