Impact of etiology on the outcomes in heart failure patients treated with cardiac resynchronization therapy: a meta-analysis.

Yanmei Chen,Shuxin Shen,Chongyang Duan,Feng Liu,Pingyan Chen,Jianping Bin,Toru Hosoda

doi:10.1371/journal.pone.0094614

Yanmei Chen, Shuxin Shen + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0094614

Copy DOI

Journal: PloS one	Publication Date: Apr 14, 2014
Citations: 27	License type: CC BY 4.0

Affiliation: Southern Medical University, Nanfang Hospital

Abstract

BackgroundCardiac resynchronization therapy (CRT) has been extensively demonstrated to benefit heart failure patients, but the role of underlying heart failure etiology in the outcomes was not consistently proven. This meta-analysis aimed to determine whether efficacy and effectiveness of CRT is affected by underlying heart failure etiology.Methods and ResultsSearches of MEDLINE, EMBASE and Cochrane databases were conducted to identify RCTs and observational studies that reported clinical and functional outcomes of CRT in ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) patients. Efficacy of CRT was assessed in 7 randomized controlled trials (RCTs) with 7072 patients and effectiveness of CRT was evaluated in 14 observational studies with 3463 patients In the pooled analysis of RCTs, we found that CRT decreased mortality or heart failure hospitalization by 29% in ICM patients (95% confidence interval [CI], 21% to 35%), and by 28% (95% CI, 18% to 37%) in NICM patients. No significant difference was observed between the 2 etiology groups (P = 0.55). In the pooled analysis of observational studies, however, we found that ICM patients had a 54% greater risk for mortality or HF hospitalization than NICM patients (relative risk: 1.54; 95% CI: 1.30–1.83; P<0.001). Both RCTs and observational studies demonstrated that NICM patients had greater echocardiographic improvements in the left ventricular ejection fraction and end-systolic volume, as compared with ICM patients (both P<0.001).ConclusionCRT might reduce mortality or heart failure hospitalization in both ICM and NICM patients similarly. The improvement of the left ventricular function and remodeling is greater in NICM patients.

Highlights

Cardiac resynchronization therapy (CRT) has been extensively demonstrated on improving symptoms, cardiac function and survival of heart failure (HF) patients [1]
The improvement of the left ventricular function and remodeling is greater in nonischemic cardiomyopathy (NICM) patients
When the analysis was limited to the studies of ICD therapy in both arms (CRT-D versus ICD), the benefits of CRT-D were observed again in ischemic cardiomyopathy (ICM) and NICM patients (Figure S5B). In this meta-analysis focused on the role of HF etiology in CRT efficacy and effectiveness, the data of 7 randomized controlled trials (RCTs) demonstrated a definite efficacy of CRT therapy in reduction of mortality or HF hospitalization in both ICM and NICM patients without significant difference between the 2 etiology groups

Summary

Introduction

Cardiac resynchronization therapy (CRT) has been extensively demonstrated on improving symptoms, cardiac function and survival of heart failure (HF) patients [1]. In addition to the primary outcomes of mortality and HF hospitalization, we examined the secondary outcomes of echocardiographic and functional improvements This meta-analysis aimed at determining whether HF etiology may affect the CRT efficacy (outcomes in RCTs) and the CRT effectiveness (outcomes in observational studies). Cardiac resynchronization therapy (CRT) has been extensively demonstrated to benefit heart failure patients, but the role of underlying heart failure etiology in the outcomes was not consistently proven. This meta-analysis aimed to determine whether efficacy and effectiveness of CRT is affected by underlying heart failure etiology

Results

Discussion

Conclusion