Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Internal Medicine, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida.
JACC Heart Fail. 2018 Sep;6(9):734-742. doi: 10.1016/j.jchf.2018.02.016. Epub 2018 Aug 8.
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.
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.
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).
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%).
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.
本研究旨在评估心力衰竭（HF）依赖正性肌力药物治疗的患者接受心脏再同步化治疗（CRT）后的结局，以明确 CRT 在这些患者中的应用价值。
在过去十年中，大量临床试验已经证实 CRT 治疗 HF 伴收缩功能障碍、QRS 波群时限延长和纽约心脏协会（NYHA）心功能分级 III 或 IV 级患者的有益作用。然而，目前尚不确定 CRT 是否可能使需要正性肌力药物支持的患者获益。
作者系统检索了 Medline、Embase、Scopus 和 Cochrane 图书馆，检索时限截至 2017 年 3 月，以评估 HF 依赖正性肌力药物治疗的患者接受 CRT 后的结局。本研究分析了 8 项研究共 151 例患者。大多数患者 NYHA 心功能分级为 IV 级（80.1%），均患有严重的收缩性 HF，左心室射血分数＜30%，体表心电图存在明显的室内传导延迟（QRS 波群时限＞130 ms）。
汇总分析显示，93%（95%置信区间：86%100%）的患者在 CRT 后可撤去正性肌力药物支持，总的 12 个月生存率为 69%（95%置信区间：56%83%）。
本研究提示，HF 依赖正性肌力药物治疗的患者接受挽救性 CRT 可能是一种可行的治疗选择。在这些患者中，挽救性 CRT 可能使他们撤去正性肌力药物治疗，改善生活质量，降低死亡率；此外，挽救性 CRT 可能作为心脏移植或左心室辅助装置治疗的一种可能的桥接手段。
