PMID- 17599447
OWN - NLM
STAT- MEDLINE
DCOM- 20070816
LR  - 20131121
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 100
IP  - 1
DP  - 2007 Jul 1
TI  - Cardiac resynchronization therapy in patients with end-stage inotrope-dependent 
      class IV heart failure.
PG  - 90-3
AB  - Although cardiac resynchronization therapy (CRT) is beneficial in patients with 
      drug-refractory New York Heart Association (NYHA) class III/IV heart failure (HF) 
      and left ventricular (LV) dyssynchrony, CRT efficacy is not well established in 
      patients with more advanced HF on inotropic support. Ten patients (age 55 +/- 13 
      years) with inotrope-dependent class IV HF (nonischemic [n = 6] and ischemic [n = 
      4]) received a CRT implantable cardioverter-defibrillator device. QRS duration 
      was 153 +/- 25 ms (left branch bundle block [n = 7], intraventricular conduction 
      delay [n = 2], and QRS <120 ms [n = 1]). The indication for CRT was based on 
      either electrocardiographic criteria (n = 9) or echocardiographic evidence of LV 
      dyssynchrony (n = 1). Intravenous inotropic therapy consisted of dobutamine (n = 
      6; 4.3 +/- 1.9 microg/kg/min) or milrinone (n = 4; 0.54 +/- 0.19 microg/kg/min) 
      as inpatient (n = 3) or outpatient (n = 7) therapy for 146 +/- 258 days before 
      CRT. One patient required ventilatory support before and during device 
      implantation. All patients were alive at follow-up 1,088 +/- 284 days after CRT. 
      Three patients underwent successful orthotopic cardiac transplantation after 56, 
      257, and 910 days of CRT. HF improved in 9 patients to NYHA classes II (n = 5) 
      and III (n = 4). Intravenous inotropic therapy was discontinued in 9 of 10 
      patients after 15 +/- 14 days of CRT. LV volumes decreased (end-diastolic from 
      226 +/- 78 to 212 +/- 83 ml; p = 0.08; end-systolic from 174 +/- 65 to 150 +/- 78 
      ml; p <0.01). LV ejection fraction increased (23.5 +/- 4.3% to 32.0 +/- 9.1%; p 
      <0.05). No implantable cardioverter-defibrillator shocks were recorded, and 
      antitachycardia therapy for ventricular tachyarrhythmias was delivered in 1 
      patient. In conclusion, patients with end-stage inotrope-dependent NYHA class IV 
      HF and LV dyssynchrony may respond favorably to CRT with long-term clinical 
      benefit and improved LV function.
FAU - Herweg, Bengt
AU  - Herweg B
AD  - Division of Cardiology, Tampa General Hospital, University of South Florida 
      College of Medicine, Tampa, Florida, USA. bherweg@hsc.usf.edu
FAU - Ilercil, Arzu
AU  - Ilercil A
FAU - Cutro, Ray
AU  - Cutro R
FAU - Dewhurst, Robert
AU  - Dewhurst R
FAU - Krishnan, Sendhil
AU  - Krishnan S
FAU - Weston, Mark
AU  - Weston M
FAU - Barold, S Serge
AU  - Barold SS
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20070515
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Cardiotonic Agents)
RN  - 3S12J47372 (Dobutamine)
RN  - JU9YAX04C7 (Milrinone)
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Cardiac Pacing, Artificial
MH  - Cardiotonic Agents/*administration & dosage
MH  - Defibrillators, Implantable
MH  - Dobutamine/administration & dosage
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Conduction System
MH  - Heart Failure/complications/*therapy
MH  - Heart Transplantation
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Milrinone/administration & dosage
MH  - Severity of Illness Index
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/complications/*therapy
EDAT- 2007/06/30 09:00
MHDA- 2007/08/19 09:00
CRDT- 2007/06/30 09:00
PHST- 2006/09/27 00:00 [received]
PHST- 2007/02/12 00:00 [revised]
PHST- 2007/02/12 00:00 [accepted]
PHST- 2007/06/30 09:00 [pubmed]
PHST- 2007/08/19 09:00 [medline]
PHST- 2007/06/30 09:00 [entrez]
AID - S0002-9149(07)00613-3 [pii]
AID - 10.1016/j.amjcard.2007.02.058 [doi]
PST - ppublish
SO  - Am J Cardiol. 2007 Jul 1;100(1):90-3. doi: 10.1016/j.amjcard.2007.02.058. Epub 
      2007 May 15.