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Eur J Heart Fail ; 7(2): 215-7, 2005 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-15701469

RESUMO

BACKGROUND: Patients with refractory heart failure requiring inotropic support have a very poor prognosis. Cardiac resynchronization therapy (CRT) offers symptomatic and possibly a survival benefit for patients with stable chronic heart failure (CHF) and a prolonged QRS, but its role in the management of end-stage heart failure requiring inotropic support has not been evaluated. METHODS: We performed a retrospective observational study of patients undergoing CRT at our institution. RESULTS: We identified 10 patients who required inotropic support for refractory CHF and who underwent CRT while on intravenous inotropic agents. Patients had been in hospital for 30+/-29 days and had received inotropic support for 11+/-6 days prior to CRT. All patients were weaned from inotropic support (2+/-2 days post-CRT) and all patients survived to hospital discharge (12+/-13 days post-CRT). Furosemide dose fell from 160+/-38 mg on admission to 108+/-53 mg on discharge (p<0.01). Serum creatinine fell from 192+/-34 micromol/l prior to CRT to 160+/-37 micromol/l on discharge (p<0.05). Serum sodium was 131+/-4 mmol/l prior to CRT and remained low at 132+/-5 mmol/l on discharge. At short-term follow up (mean 47 days), all patients were alive; mean furosemide dose was 130+/-53 mg (p=0.056 versus pre-CRT). Serum creatinine was 157+/-36 micromol/l and serum sodium had increased to 138+/-6 mmol/l (p<0.05 and p<0.01, respectively, versus pre-CRT). CONCLUSION: CRT may offer a new therapeutic option for inotrope-supported CHF patients with a prolonged QRS.


Assuntos
Estimulação Cardíaca Artificial , Cardiotônicos/administração & dosagem , Insuficiência Cardíaca/terapia , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Diuréticos/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Furosemida/administração & dosagem , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
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