Cardiac resynchronization therapy in inotrope‐dependent heart failure: a meta‐analysis
Aims: The viability of cardiac resynchronization therapy (CRT) in inotrope‐dependent heart failure (HF) has been a matter of debate. Methods and results: We searched Medline, EMBASE, Scopus, and the Cochrane Library until 31 December 2022. Studies were included if (i) HF patients required inotropic...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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Wiley Open Access
2024
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| _version_ | 1817930882055405568 |
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| author | Al‐Shakarchi, NJ Ho, JS Bray, JJ D'Ascenzo, F Duffy, E Hewett, J Adegbie, D Khan, F Kumar, NS Patel, N Ahmad, M Banerjee, A Haq, I Providencia, R |
| author_facet | Al‐Shakarchi, NJ Ho, JS Bray, JJ D'Ascenzo, F Duffy, E Hewett, J Adegbie, D Khan, F Kumar, NS Patel, N Ahmad, M Banerjee, A Haq, I Providencia, R |
| author_sort | Al‐Shakarchi, NJ |
| collection | OXFORD |
| description | Aims: The viability of cardiac resynchronization therapy (CRT) in inotrope‐dependent heart failure (HF) has been a matter of debate. Methods and results: We searched Medline, EMBASE, Scopus, and the Cochrane Library until 31 December 2022. Studies were included if (i) HF patients required inotropic support at CRT implantation; (ii) patients were ≥18 years old; and (iii) they provided a clear definition of ‘inotrope dependence’ or ‘inability to wean’. A meta‐analysis was performed in R (Version 3.5.1). Nineteen studies comprising 386 inotrope‐dependent HF patients who received CRT (mean age 64.4 years, 76.9% male) were included. A large majority survived until discharge at 91.1% [95% confidence interval (CI): 81.2% to 97.6%], 89.3% were weaned off inotropes (95% CI: 77.6% to 97.0%), and mean discharge time post‐CRT was 7.8 days (95% CI: 3.9 to 11.7). After 1 year of follow‐up, 69.7% survived (95% CI: 58.4% to 79.8%). During follow‐up, the mean number of HF hospitalizations was reduced by 1.87 (95% CI: 1.04 to 2.70, P < 0.00001). Post‐CRT mean QRS duration was reduced by 29.0 ms (95% CI: −41.3 to 16.7, P < 0.00001), and mean left ventricular ejection fraction increased by 4.8% (95% CI: 3.1% to 6.6%, P < 0.00001). The mean New York Heart Association (NYHA) class post‐CRT was 2.7 (95% CI: 2.5 to 3.0), with a pronounced reduction of individuals in NYHA IV (risk ratio = 0.27, 95% CI: 0.18 to 0.41, P < 0.00001). On univariate analysis, there was a higher prevalence of males (85.7% vs. 40%), a history of left bundle branch block (71.4% vs. 30%), and more pronounced left ventricular end‐diastolic dilation (274.3 ± 7.2 vs. 225.9 ± 6.1 mL). Conclusions: CRT appears to be a viable option for inotrope‐dependent HF, with some of these patients seeming more likely to respond. |
| first_indexed | 2024-09-25T04:16:28Z |
| format | Journal article |
| id | oxford-uuid:0c4b1827-9d81-4405-afc7-24f414a77be3 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-12-09T03:13:11Z |
| publishDate | 2024 |
| publisher | Wiley Open Access |
| record_format | dspace |
| spelling | oxford-uuid:0c4b1827-9d81-4405-afc7-24f414a77be32024-10-16T09:13:41ZCardiac resynchronization therapy in inotrope‐dependent heart failure: a meta‐analysisJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:0c4b1827-9d81-4405-afc7-24f414a77be3EnglishJisc Publications RouterWiley Open Access2024Al‐Shakarchi, NJHo, JSBray, JJD'Ascenzo, FDuffy, EHewett, JAdegbie, DKhan, FKumar, NSPatel, NAhmad, MBanerjee, AHaq, IProvidencia, RAims: The viability of cardiac resynchronization therapy (CRT) in inotrope‐dependent heart failure (HF) has been a matter of debate. Methods and results: We searched Medline, EMBASE, Scopus, and the Cochrane Library until 31 December 2022. Studies were included if (i) HF patients required inotropic support at CRT implantation; (ii) patients were ≥18 years old; and (iii) they provided a clear definition of ‘inotrope dependence’ or ‘inability to wean’. A meta‐analysis was performed in R (Version 3.5.1). Nineteen studies comprising 386 inotrope‐dependent HF patients who received CRT (mean age 64.4 years, 76.9% male) were included. A large majority survived until discharge at 91.1% [95% confidence interval (CI): 81.2% to 97.6%], 89.3% were weaned off inotropes (95% CI: 77.6% to 97.0%), and mean discharge time post‐CRT was 7.8 days (95% CI: 3.9 to 11.7). After 1 year of follow‐up, 69.7% survived (95% CI: 58.4% to 79.8%). During follow‐up, the mean number of HF hospitalizations was reduced by 1.87 (95% CI: 1.04 to 2.70, P < 0.00001). Post‐CRT mean QRS duration was reduced by 29.0 ms (95% CI: −41.3 to 16.7, P < 0.00001), and mean left ventricular ejection fraction increased by 4.8% (95% CI: 3.1% to 6.6%, P < 0.00001). The mean New York Heart Association (NYHA) class post‐CRT was 2.7 (95% CI: 2.5 to 3.0), with a pronounced reduction of individuals in NYHA IV (risk ratio = 0.27, 95% CI: 0.18 to 0.41, P < 0.00001). On univariate analysis, there was a higher prevalence of males (85.7% vs. 40%), a history of left bundle branch block (71.4% vs. 30%), and more pronounced left ventricular end‐diastolic dilation (274.3 ± 7.2 vs. 225.9 ± 6.1 mL). Conclusions: CRT appears to be a viable option for inotrope‐dependent HF, with some of these patients seeming more likely to respond. |
| spellingShingle | Al‐Shakarchi, NJ Ho, JS Bray, JJ D'Ascenzo, F Duffy, E Hewett, J Adegbie, D Khan, F Kumar, NS Patel, N Ahmad, M Banerjee, A Haq, I Providencia, R Cardiac resynchronization therapy in inotrope‐dependent heart failure: a meta‐analysis |
| title | Cardiac resynchronization therapy in inotrope‐dependent heart failure: a meta‐analysis |
| title_full | Cardiac resynchronization therapy in inotrope‐dependent heart failure: a meta‐analysis |
| title_fullStr | Cardiac resynchronization therapy in inotrope‐dependent heart failure: a meta‐analysis |
| title_full_unstemmed | Cardiac resynchronization therapy in inotrope‐dependent heart failure: a meta‐analysis |
| title_short | Cardiac resynchronization therapy in inotrope‐dependent heart failure: a meta‐analysis |
| title_sort | cardiac resynchronization therapy in inotrope dependent heart failure a meta analysis |
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