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Suboptimal medical therapy in patients with systolic heart failure is associated with less improvement by cardiac resynchronization therapy
- Source :
-
International Journal of Cardiology . Feb2007, Vol. 115 Issue 2, p214-219. 6p. - Publication Year :
- 2007
-
Abstract
- Abstract: Background: Proven medical therapy is under-prescribed in heart failure (HF) for various reasons. Cardiac resynchronization therapy (CRT) is of proven value in selected patients with HF; however, the degree of benefit in those without the optimal therapy is not clear. Methods: This is a retrospective study comparing the effect of CRT in 30 patients without optimal combination therapy (group 1; 10 (33%) without ACEi or equivalent and 25 (83%) without beta-blockers) to an age, sex, ejection fraction (EF) and New York Heart Association (NYHA) class matched control but with the combination (group 2; n =30) at baseline. All patients were in NYHA class III or IV with EF ≤35% and QRS interval≥120 ms. Echocardiographic examination and N-terminal pro-brain natriuretic peptide (NT pro-BNP) levels before and 3 months after CRT were compared between the two groups. The composite endpoints of HF hospitalization or death during follow-up were compared by Kaplan–Meier analysis. Results: There were significantly less improvement in EF (+4.0±2.5% vs +10.1±3.2%; p <0.05) and degree of reverse remodeling in group 1 after 3 months. Patients in group 1 had significantly higher level of NT pro-BNP levels at 3 months (2221±2001 pg/mL vs 1038±905 pg/mL; p <0.001) and higher rates of HF hospitalization or death (53.3% vs 23.3%; Log rank χ 2 5.52; p =0.019). Conclusion: Patients receiving CRT but without optimal medical therapy were associated with less echocardiographic and clinical improvement. Optimal medical therapy, if tolerated, before CRT is necessary. [Copyright &y& Elsevier]
- Subjects :
- *HEART failure
*CARDIAC arrest
*HOSPITAL care
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 01675273
- Volume :
- 115
- Issue :
- 2
- Database :
- Academic Search Index
- Journal :
- International Journal of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 23806081
- Full Text :
- https://doi.org/10.1016/j.ijcard.2006.04.034