Clinical InvestigationRole of Cardiac Resynchronization in End-Stage Heart Failure Patients Requiring Inotrope Therapy
Section snippets
Patient Selection
We conducted a systemic review of the medical records of all patients (n = 759) receiving CRT-defibrillators (CRT-D) for currently accepted indications10, 11 from 2002–2008 at Presbyterian University Hospital. As such, all study patients had left ventricular ejection fraction (LVEF) ≤35%, QRS duration ≥120 ms, and NYHA functional class 3-4 HF despite optimally tolerated medical therapy. Patients who had ever been treated with intravenous milrinone or dobutamine were identified and divided into
Baseline Characteristics
Baseline characteristics of the study groups are listed in Table 1. The four primary cohorts (NI, PI, II, and SD) differed in baseline renal function, HF etiology, and incidence of diabetes, right bundle branch-block, NYHA functional class 4 HF, and β-blocker use. The higher incidence of NYHA functional class 4 HF and lower β-blocker use in the II group was expected, given the inability to wean these patients from inotropes. After adjusting for the multiple propensity scores, all baseline
Discussion
We have described the outcomes of a large modern cohort of inotrope-treated CRT recipients at an academic hospital and placed these findings into perspective by comparison with CRT recipients never treated with inotropes and a group of patients with unsuccessful CRT implantation who received an SD. Propensity score analysis was used to control for baseline differences among the groups; the II cohort, in particular, was associated with more baseline comorbid conditions. Both survival free from
Conclusions
In this retrospective single-center analysis of HF patients receiving CRT while on modern background medical therapy, survival free from cardiac transplantation or VAD and overall survival differed significantly according to whether patients had never been on intravenous inotropes, had received inotropes in the past, were on inotropes at implantation, or did not receive a left ventricular lead. Patients who were inotrope-dependent at implant had particularly poor survival, and this was
Acknowledgments
The authors thank the Electrophysiology and Advanced Heart Failure/Transplant physicians and staff at Presbyterian University Hospital for their efforts in providing clinical care for the patients involved in this study.
Disclosures
Drs. Bhattacharya, Abebe, Simon, and Adelstein have no financial disclosures. Dr. Saba receives research support from Boston Scientific, Medtronic, and St. Jude Medical and serves as a consultant for St. Jude Medical.
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This publication was made possible by grant no. UL1 RR024153 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH.”
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