{"id":"421f7eb5969f","type":"article","url":"https://hartvaat.nl/2020/03/31/staken-van-neurohumorale-blokkade-na-crt/","title":"Staken van neurohumorale blokkade na CRT","title_en":"Withdrawal of Neurohumoral Blockade After Cardiac Resynchronization Therapy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.01.040","source_url":"https://doi.org/10.1016/j.jacc.2020.01.040","authors":["Petra Nijst","Pieter Martens","Jeroen Dauw","W H Wilson Tang","Philippe B Bertrand","Joris Penders","Liesbeth Bruckers","Gabor Voros","Rik Willems","Pieter M Vandervoort","Matthias Dupont","Wilfried Mullens"],"significance":5,"published":"2020-03-31","source_date":"2020-03-31","image":"","kennis":[],"congress":"","summary_en":"This study investigated whether neurohumoral blockers can be safely withdrawn in patients who achieve normalized ejection fraction after CRT, addressing a common clinical question about medication de-escalation in CRT super-responders.","created":"2026-07-03T10:28:29Z","updated":"2026-07-03T13:27:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het staken van neurohumorale blokkade bij patiënten die goed reageren op CRT.","abstract_original":"BACKGROUND: The necessity of neurohumoral blockers in patients with heart failure who demonstrate normalized ejection fractions after cardiac resynchronization therapy remains unclear. OBJECTIVES: The aim of this study was to investigate the feasibility and safety of neurohumoral blocker withdrawal in patients with normalized ejection fractions after cardiac resynchronization therapy. METHODS: In this prospective, open-label, randomized controlled pilot trial with a 2 × 2 factorial design, subjects were randomized to withdrawal of renin-angiotensin-aldosterone system inhibitors and/or beta-blockers versus continuation of treatment. The primary endpoint was a recurrence of negative remodeling, defined as an increase in left ventricular end-systolic volume index of >15% at 24 months. The secondary endpoint was a composite safety endpoint of all-cause mortality, heart failure-related hospitalizations, and incidence of sustained ventricular arrhythmias at 24 months. RESULTS: Eighty subjects were consecutively enrolled and randomized among 4 groups (continuation of neurohumoral blocker therapy, n = 20; withdrawal of renin-angiotensin-aldosterone system inhibitors, n = 20; withdrawal of beta-blockers, n = 20; and withdrawal of renin-angiotensin-aldosterone system inhibitors and beta-blockers, n = 20). Of the 80 subjects, 6 (7.5%) met the primary and 4 (5%) the secondary endpoint. However, re-initiation of neurohumoral blockers occurred in 17 subjects because of hypertension or supraventricular arrhythmias. CONCLUSIONS: The incidence of the primary and secondary endpoints over a follow-up period of 2 years was low in both the control group and in the groups in which neurohumoral blockers were discontinued. However, neurohumoral blocker withdrawal was hampered by cardiac comorbidities. (Systematic Withdrawal of Neurohumoral Blocker Therapy in Optimally Responding CRT Patients [STOP-CRT]; NCT02200822)."}