Should cardiac resynchronization therapy be a rescue therapy for inotrope-dependent patients with advanced heart failure?
BACKGROUND
Although the "off-label usage" of cardiac resynchronization therapy with defibrillator (CRT-D) has spread recently in advanced heart failure (HF) patients in the real-world practice, its clinical effect remained uncertain.


RESULTS
A total of 84 in-hospital <65-year old patients with advanced HF undergoing CRT-D were enrolled. Seventeen patients (20%) had been dependent on inotropes at the time of CRT-D implantation, and 17 suffered cardiac death within a year. Both inotrope dependence and elevated plasma levels of B-type natriuretic peptide (BNP) (>690 pg/mL) at the time of CRT-D implantation were independent predictors of cardiac death within a year by Cox regression analyses (P < 0.05 for both). These 2 parameters could significantly stratify 1-year ventricular assist device (VAD)-free survival: inotrope-free low (1) or high BNP (2), or inotrope-dependent low (3) or high BNP groups (4) (98, 77, 57, and 17%, respectively, P < 0.001). In contrast, there were no significant differences in actual 1-year survival among the four groups.


CONCLUSIONS
Patients dependent on inotropes sometimes receive CRT-D therapy as the last treatment resort in clinical practice, but LVAD implantation should be considered instead of CRT-D in advanced HF patients because of their poor prognosis with CRT-D therapy.
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Teruhiko
T
Imamura
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Electronic address: kinugawa-tky@umin.ac.jp.
Koichiro
K
Kinugawa
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Daisuke
D
Nitta
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Masaru
M
Hatano
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Issei
I
Komuro
D000328:Adult; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000379:methods; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D017147:Defibrillators, Implantable; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D020097:Natriuretic Peptide, Brain
INTERMACS; catecholamine; reverse remodeling; ventricular assist device