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

Kachboura, Salem; Halima, Afef Ben; Elhadj, Zied Ibn; Marrakchi, S.; Chrigui, Rym; Kammoun, Ikram; Chine, Samira; Lefi, Abdellatif

doi:10.1016/j.ancard.2013.02.002

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…Implantation of CRT also provides a safety net that should encourage the titration of BB to higher doses to achieve a resting HR of 50-60 bpm [22]. However, only a few studies of the effect of CRT on optimizing pharmacotherapy have been published [14,18,22,23]. The IMPROVE-HF trial demonstrated that patients with CRT were more likely to be treated with a target dose of BB than patients who were not treated with device therapy [18].…”

Section: Crt As a Provider For Bb Optimizationmentioning

confidence: 96%

Prognostic significance of beta-blocker up-titration in conjunction with cardiac resynchronization therapy in heart failure management

et al. 2015

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Clinical practice guidelines emphasize that optimal pharmacotherapy, including beta-blockers (BB), is a prerequisite before receiving cardiac resynchronization therapy (CRT) in eligible patients with heart failure (HF). However, the optimal dose of BB before CRT implantation cannot be tolerated in a number of patients. Sixty-three consecutive patients who underwent CRT in 2006-2013 were retrospectively investigated. Before receiving CRT, BB could not be introduced in 20 patients (32 %); the daily carvedilol-equivalent dose in other 43 patients was 5.6 ± 7.0 mg because of significant HF and bradycardia. After receiving CRT, BB could be introduced in almost all patients (n = 61, 97 %), and the daily BB dose increased from 5.6 ± 7.0 to 13.2 ± 7.8 mg (P < 0.001). Multivariate analysis indicated that the change of BB dose after CRT was independently associated with improved left ventricular end-systolic volume (LVESV) [β = -0.36; 95 % confidence interval (CI) -2.13 to -0.45; P < 0.01] after 6-months follow-up. Furthermore, Cox proportional hazard analysis also showed that the change in the BB dose (hazard ratio, 0.92; 95 % CI, 0.87-0.98; P < 0.01) as well as the New York Heart Association functional classification was an independent predictor of cardiac events. After initiating CRT, BB therapy can be introduced and up-titrated in intolerant HF patients. The up-titrated dose of BB after CRT was an independent predictor for the improvement of LVESV and HF prognosis.

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Section: Crt As a Provider For Bb Optimizationmentioning

confidence: 96%

Prognostic significance of beta-blocker up-titration in conjunction with cardiac resynchronization therapy in heart failure management

et al. 2015

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“…However due to the complex changes in physiology which may also be exploited by adjusting prognostically beneficial heart failure medication, within our data the patients who became hyponatremic by the end of 6 months did have reduced survival and increased hospitalisation. 19 This may reflect a failure to undergo left ventricular remodelling or have other beneficial responses due to advanced biventricular disease 6 months after implantation and may have a predictive value in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac output and blood pressure usually rise in responders after CRT allowing up-titration of HF medication and consequent alteration of sodium balance. 19 …”

Section: Discussionmentioning

confidence: 99%

The prognostic significance of serum sodium in a population undergoing cardiac resynchronisation therapy

Guha

Spießhöfer

Hartley

et al. 2017

Indian Heart Journal

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PurposeTo determine the prognostic implications of changes towards hyponatremia at varying time-points in the treatment of patients undergoing cardiac resynchronisation therapy (CRT).MethodsA retrospective series of 249 patients was studied from 2002 to 2013. The population was categorized on the basis of serum sodium profile at baseline, at 1 month and at 6 month follow up visits following successful CRT implantation. The composite endpoint was all-cause mortality and heart failure hospitalisation (defined by the need for intravenous diuretic therapy) following CRT implantation.ResultsA total of 249 patients (67.8 ± 12.5 years; NYHA class III/IV 75; LVEF 27.2 ± 8.8%) were followed up for a median of 5.5 years. Hyponatremia at baseline, 1 month or 6 months follow up did not predict the composite endpoint. 26% of patients showed hyponatremia at baseline prior to CRT implantation, while it was present in 19.9% of patients 1 month (p = 0.003) and in 16% (p < 0.001) 6 months after CRT implantation. There was a significantly worse outcome for those patients who developed hyponatremia 6 months after CRT implantation. In multivariate analysis, the intake of loop diuretics (HR 1.76 [1.04–2.95], p = 0.03) and renal impairment (urea > 7.0 mmol/l) (HR 1.61 [1.05–2.46], p = 0.03) at baseline were associated with an increased risk of unplanned heart failure hospitalisation and all-cause mortality after CRT implantation.ConclusionsA change towards hyponatremia when observed 6 months after CRT implantation may predict a worse clinical outcome. Additionally, renal impairment and higher diuretic doses are associated with an increased risk of mortality in the population analysed.

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“…Moreover, the doses of heart failure medications are often limited due to their adverse effects (bradycardia, hypotension, renal dysfunction etc.). CRT improves hemodynamic function and blood pressure facilitating the optimization of medical treatment especially the introduction and up‐titration of beta‐blockers . Therefore, it is important that medical treatment must be reevaluated after CRT implantation.…”

Section: Clinical Evaluation: Reevaluate Medications Check For Comormentioning

confidence: 99%

“…Therefore, it is important that medical treatment must be reevaluated after CRT implantation. Achieving maximal doses of medication after CRT prove that CRT and medical treatment are complementary strategies .…”

Section: Clinical Evaluation: Reevaluate Medications Check For Comormentioning

confidence: 99%

How to follow a patient with heart failure and a biventricular device

Theofilogiannakos

Vassilikos

2016

Continuing Cardiol Educ

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Cardiac resynchronization therapy is the gold standard therapy for patients with moderate to severe heart failure symptoms on optimal medical treatment, with left ventricular ejection fraction <35% and broad QRS (>120 msec). However, one‐third of them do not respond to CRT (defines as no any functional/symptomatic improvement and/or without left ventricular reverse remodeling). Some patients might potentially be responders if manages properly and for this reason, patient after CRT implantation should be followed up regularly. Given that a CRT patient is mainly a heart failure patient, follow up should not be focused only on device interrogation but it is essential to optimize the overall heart failure of the patient. This paper reviews the stages of an outpatient follow up of a CRT patient focusing primarily on the nonresponders management. Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/4596349/Activity.aspx

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

Cited by 8 publications

References 23 publications

Prognostic significance of beta-blocker up-titration in conjunction with cardiac resynchronization therapy in heart failure management

Prognostic significance of beta-blocker up-titration in conjunction with cardiac resynchronization therapy in heart failure management

The prognostic significance of serum sodium in a population undergoing cardiac resynchronisation therapy

How to follow a patient with heart failure and a biventricular device

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