Cardiac resynchronization therapy (CRT), combined with optimal medical therapy (OMT), is an established treatment for patients with advanced chronic heart failure (ACHF). In ACHF, carvedilol at the dose used in clinical trials reduces morbidity and mortality. However, patients often cannot tolerate the drug at the targeted dosage. Aim of the CARIBE-HF prospective observational study was to investigate the role of CRT in the implementation of carvedilol therapy in patients with ACHF. Methods: One hundred and 6 patients (aged 65±12 [mean±sd] years) with ACHF were enrolled and treated with OMT, in which carvedilol was titrated up to the maximal dose (phase 1). Subsequently, patients with left ventricular (LV) ejection fraction < 35%, NYHA class III-IV and QRS interval ≥ 120 msec were assigned to CRT. Both CRT and NO-CRT patients underwent long-term follow-up till 7 years (1193,98±924 days), while efforts to up-titrate the carvedilol dose were continued during the second phase (471±310 days). Phase 1 was completed by 84 patients (79%), and 15 (18%) underwent CRT. The mean carvedilol dose in the CRT group was 19.0±17.8 mg, against 32.7±19.1 mg in the remaining 69 patients (p=0.018). At the end of phase 2, CRT patients presented a significantly greater variation of increasing in the carvedilol dose than NO-CRT patients ( 20.0±19.8 mg vs –0.3±20.5 mg; p=0.015), a greater NYHA class reduction (-0.8±0.6 vs -0.2±0.7; p=0.011), and a greater increase in LV ejection fraction ( 10.8±9 vs 3.1±6.1; p=0.018). In conclusion, the data from the CARIBE study suggest that, in ACHF, CRT may be effective in enabling the target dose of carvedilol to be reached. The significant improvement seen in LV function was probably due to a synergistic effect of CRT and carvedilol. During the extended follow-up (mean 1193,98±924 days) the mean dosage of carvedilol in CRT group was significantly higher (p<0.02).

Terapia de resincronizare cardiacă (CRT), în asociere cu tratamentul optim medical (OMT), este recunoscută pentru pacienţii cu insufi cienţă cardiacă cronică avansată (ACHF). În ACHF, carvedilolul la doza utilizată în studiile clinice reduce morbiditatea şi mortalitatea. Cu toate acestea, de multe ori pacienţii nu pot tolera beta-blocantul, la doza ţintă. Scopul studiului CARIBE-HF observaţional prospectiv a fost de a investiga rolul CRT în asocierea cu carvedilol la pacienţii cu ACHF. Metodă: 106 pacienţi (cu vârsta de 65 ± 12 [media ± SD] de ani), cu ACHF au fost înrolaţi şi trataţi cu OMT, care a fost carvedilolul titrat la doza maximă (faza 1). Ulterior, pacienţii cu fracţia de ejecţie (VS) <35%, clasa NYHA III-IV şi QRS interval de ≥ 120 m/sec au fost supuşi CRT. Ambele grupe de pacienţi CRT şi CRT-NO au fost urmărite până la 7 ani (1193,98 ± 924 zile), în timp ce titrarea în sus a dozei de carvedilol au continuat în faza a doua (471 ± 310 zile). La faza I au fost incluşi 84 de pacienţi (79%), iar 15 (18%) au fost supuse CRT. Doza medie carvedilol în grupul CRT a fost de 19.0 ± 17.8 mg, versus 32.7 ± 19.1 mg la alţi 69 de pacienţi (p = 0,018). La sfârşitul fazei 2, pacienţii cu CRT au prezentat o variaţie semnifi cativ mai mare de creştere a dozei de carvedilol decât pacienţii non-CRT (20.0 ± 19.8 mg vs -0.3 ± 20.5 mg, p = 0,015), o reducere a NYHA clasa (- 0,8 ± 0.6 vs -0.2 ± 0.7, p = 0,011), precum şi o creştere mai mare a fracţiei de ejecţie VS ( 10,8 ± 9 vs 3.1 ± 6.1, p = 0,018).

Сердечная ресинхронизация (CRT), в сочетании с оптимальной медикаментозной терапии (ОМТ), является апробированным лечения пациентов с выраженной хронической сердечной недостаточности (ACHF). При ACHF, карведилол, используемый в клинических исследованиях снижает смертность. Тем не менее, пациенты часто не переносят препарат в целевой дозы. Цель CARIB-HF исследования было изучение роли CRT в комбинации с карведилола у пациентов с ACHF. Методы: 106 пациентов (в возрасте 65 ± 12 [средняя ± SD] лет) с ACHF были включены в исследовании с OMT, в котором карведилола был титрован до максимальной дозы (фаза 1). Впоследствии пациенты с фракцией выброса <35%, NYHA класс III-IV QRS и интервала >120 мс была проведена CRT. Обе группы больных с ОМТ и non-CRT больным наблюдались до 7 лет (1193,98 ± 924 дней), в то время предпринимались попытки повышать дозу карведилола в ходе второго этапа (471 ± 310 дней). Фаза 1 завершили 84 пациентов (79%), и 15 (18%) была CRT. Средние дозы карведилола в группе CRT был 19,0 ± 17,8 мг, против 32,7 ± 19,1 мг в оставшихся 69 пациентов (р = 0,018). В конце фазы 2, CRT пациентов представлено значительно большее изменение увеличения в дозе, чем карведилол NO-CRT пациентов (20,0 ± 19,8 мг против -0,3 ± 20,5 мг, р = 0,015), большая NYHA класс снижение (-0,8 ± 0,6 против -0,2 ± 0,7; р = 0,011) и большее увеличение фракции выброса левого желудочка ( 10,8 ± 9 против 3,1 ± 6,1, р = 0,018).