Abstract
BackgroundThe presence of left ventricular contractile reserve (LVCR) during stress echo (SE) may provide favorable response to cardiac resynchronization therapy (CRT) in heart failure patients. The aim of the study was to perform a meta-analysis of available SE data in this set of patients.MethodsFrom a Pubmed and Advance Google Scholar database web based search scan up to December 2016, we initially identified 5906 records. From this initial set, we removed that did not include SE and duplicate studies. We assessed for eligibility 71 full-text articles assessed for eligibility, and 60 of them did not meet the inclusion criteria as follow: 1) heart failure patients with NYHA class III and IV, depressed ejection fraction (EF <35%) and QRS duration ≥120 ms at study entry; 2) SE with assessment of LVCR; 3) Follow-up data. LVCR during SE was identified as reduction in wall motion score index and/or an increase in EF.ResultsEleven studies with 861 patients (mean age 67 ± 9 years, ejection fraction 25 ± 6%) were included in the meta-analysis. The type of stress was either exercise (n = 2) or dobutamine (n = 9), the latter with low-dose (10 mcg) in two, intermediate-dose (20 mcg) in five, and high-dose (40 mcg) protocol in two studies. LVCR was detected in 555 patients (63%) and CRT-response was present in 584 (66%). The overall odds ratio for LVCR to predict a favorable CRT response was 2.06 (95%, CI 1.70–2-43), Z score: 11.055, p < 0.001.ConclusionThe presence of LVCR during SE with either dobutamine or exercise is associated with a greater chance of response to CRT. This parameter is now ready to be tested in a prospective multicenter trial to select patients more likely to benefit from CRT.
Highlights
The presence of left ventricular contractile reserve (LVCR) during stress echo (SE) may provide favorable response to cardiac resynchronization therapy (CRT) in heart failure patients
The 2016 European Society of Cardiology (ESC) guidelines do not mention the role of left ventricle myocardial contractile reserve (LVCR) during stress echocardiography (SE) [4], which can be useful for predicting outcomes of several medical and surgical interventions in patients with dilated cardiomyopathy of different etiology [5]
Data abstraction According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement [7], from a Pubmed and Advance Google Scholar database web based search scan up to December 2016, we initially identified 5906 records, using the key terms CRT (5906 citations) AND SE (71 citations) AND dobutamine (19 citations) OR exercise echocardiography (7 citations)
Summary
The presence of left ventricular contractile reserve (LVCR) during stress echo (SE) may provide favorable response to cardiac resynchronization therapy (CRT) in heart failure patients. The aim of the study was to perform a meta-analysis of available SE data in this set of patients. The 2016 ESC guidelines do not mention the role of left ventricle myocardial contractile reserve (LVCR) during stress echocardiography (SE) [4], which can be useful for predicting outcomes of several medical and surgical interventions in patients with dilated cardiomyopathy of different etiology [5]. The aim of the study was to assess the evidence base underlying the possible usefulness of LVCR in CRT patients by performing a meta-analysis of available SE data Ciampi et al BMC Cardiovascular Disorders (2017) 17:223 suggest that the absence of LVCR is a strong determinant of outcome and a potential marker of response to CRT [6].
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