Cardiac resynchronization therapy allows the optimization of medical treatment in heart failure patients.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia. Electronic address: salem.kachboura@rns.tn.
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Kachboura
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia.
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Ben Halima
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia.
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Ibn Elhadj
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia.
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Marrakchi
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia.
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Chrigui
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia.
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Kammoun
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia.
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Chine
Service de cardiologie et unité de recherche scientifique UR0904, hôpital Abderrahmane Mami, CHU Abderrahmane Mami, 2080 Ariana, Tunisia.
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Lefi
D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D058406:Cardiac Resynchronization Therapy; D003131:Combined Modality Therapy; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors
D057911:Angiotensin Receptor Antagonists; D007703:Peptidyl-Dipeptidase A
ACE; ARA II; ARB; Cardiac resynchronization therapy; Heart failure; IEC; Insuffisance cardiaque; Medical treatment; Resynchronisation cardiaque; Traitement médical; β blockers; β bloquants