Feasibility and Association of Neurohumoral Blocker Up-titration After Cardiac Resynchronization Therapy

Autor: Frederik H. Verbrugge, Pieter Martens, Wilson W.H. Tang, Philippe Bertrand, Matthias Dupont, Petra Nijst, Wilfried Mullens
Přispěvatelé: Clinical sciences, Medicine and Pharmacy academic/administration, Cardiology, Intensive Care
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
Dose
medicine.medical_treatment
Cardiac resynchronization therapy
Angiotensin Receptor Antagonists/pharmacology
Angiotensin-Converting Enzyme Inhibitors/pharmacology
Angiotensin-Converting Enzyme Inhibitors
030204 cardiovascular system & hematology
Cardiac Resynchronization Therapy
Angiotensin Receptor Antagonists
03 medical and health sciences
0302 clinical medicine
Internal medicine
Cardiac Resynchronization Therapy/methods
Humans
Medicine
cardiovascular diseases
030212 general & internal medicine
Aged
Retrospective Studies
Aged
80 and over
Heart Failure
Neurotransmitter Agents
Ejection fraction
business.industry
Neurotransmitter Agents/antagonists & inhibitors
Hazard ratio
Retrospective cohort study
Middle Aged
medicine.disease
Confidence interval
Heart Failure/diagnostic imaging
Target dose
Treatment Outcome
Heart failure
Cardiology
Feasibility Studies
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Zdroj: Journal of Cardiac Failure. 23:597-605
ISSN: 1071-9164
DOI: 10.1016/j.cardfail.2017.03.001
Popis: Background Cardiac resynchronization therapy (CRT) improves mortality and morbidity on top of optimal medical therapy in heart failure with reduced ejection fraction (HFrEF). This study aimed to elucidate the association between neurohumoral blocker up-titration after CRT implantation and clinical outcomes. Methods and Results Doses of angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and beta-blockers were retrospectively evaluated in 650 consecutive CRT patients implanted from October 2008 to August 2015 and followed in a tertiary multidisciplinary CRT clinic. All 650 CRT patients were on a maximal tolerable dose of ACE-I/ARB and beta-blocker at the time of CRT implantation. However, further up-titration was successful in 45.4% for ACE-I/ARB and in 56.8% for beta-blocker after CRT-implantation. During a mean follow-up of 37 ± 22 months, a total of 139 events occurred for the combined end point of heart failure admission and all-cause mortality. Successful, versus unsuccessful, up-titration was associated with adjusted hazard ratios of 0.537 (95% confidence interval 0.316–0.913; P = .022) for ACE-I/ARB and 0.633 (0.406–0.988; P = .044) for beta-blocker on the combined end point heart failure admission and all-cause mortality. Patients in the up-titration group exhibited a similar risk for death or heart failure admission as patients treated with the maximal dose (ACE-I/ARB: P = .133; beta-blockers: P = .709). Conclusions After CRT, a majority of patients are capable of tolerating higher dosages of neurohumoral blockers. Up-titration of neurohumoral blockers after CRT implantation is associated with improved clinical outcomes, similarly to patients treated with the guideline-recommended target dose at the time of CRT implantation.
Databáze: OpenAIRE
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