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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/23650

Title: Feasibility and Association of Neurohumoral Blocker Up-titration After Cardiac Resynchronization Therapy
Authors: Martens, Pieter
Verbrugge, Frederik
Nijst, Petra
Bertrand, Philippe
Dupont, Matthias
Tang, Wilson H.
Mullens, Wilfried
Issue Date: 2017
Abstract: 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 ACEI/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.
Notes: [Martens, Pieter; Verbrugge, Frederik H.; Nijst, Petra; Bertrand, Philippe B.; Dupont, Matthias; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. [Martens, Pieter; Nijst, Petra; Bertrand, Philippe B.; Mullens, Wilfried] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Tang, Wilson H.] Cleveland Clin, Heart & Vasc Inst, Dept Cardiovasc Med, Cleveland, OH 44106 USA. [Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium.
URI: http://hdl.handle.net/1942/23650
DOI: 10.1016/j.cardfail.2017.03.001
ISI #: 000408403000005
ISSN: 1071-9164
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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