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Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial Managing Multivessel Coronary Artery Disease in Patients With ST-Elevation Myocardial Infarction: A Comprehensive Review Outcome of patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention during on- versus off-hours (a Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] trial substudy) Combining IVUS and Optical Coherence Tomography for More Accurate Coronary Cap Thickness Quantification and Stress/Strain Calculations: A Patient-Specific Three-Dimensional Fluid-Structure Interaction Modeling Approach National assessment of early β-blocker therapy in patients with acute myocardial infarction in China, 2001-2011: The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective AMI Study Long-Term Outcomes in Women and Men Following Percutaneous Coronary Intervention Clinical Significance of Concordance or Discordance Between Fractional Flow Reserve and Coronary Flow Reserve for Coronary Physiological Indices, Microvascular Resistance, and Prognosis After Elective Percutaneous Coronary Intervention Association of All-Cause and Cardiovascular Mortality With High Levels of Physical Activity and Concurrent Coronary Artery Calcification Treatment effects of systematic two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: rationale and design of a prospective, randomised and multicentre DEFINITION II trial Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options
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Review ArticleVolume 6, Issue 9, September 2018

JOURNAL：JACC: Heart Failure Article Link

Cardiac Resynchronization Therapy in Inotrope-Dependent Heart Failure Patients - A Systematic Review and Meta-Analysis

GA Hernandez, V Blumer, L Arcay et al. Keywords: cardiac resynchronization therapy; heart failure; inotropes; New York Heart Association functional class IV

ABSTRACT

OBJECTIVES - 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.


BACKGROUND - 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.

METHODS - 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).

RESULTS - 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%).

CONCLUSIONS - 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.
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