Cardiac resynchronization therapy in patients with minimal heart failure: a systematic review and meta-analysis
Abstract
OBJECTIVES: The purpose of this study was to perform a systematic review and meta-analysis of prospective randomized clinical trials of cardiac resynchronization therapy (CRT) versus implantable cardioverter-defibrillator (ICD) in patients with reduced ejection fraction (EF), prolonged QRS interval, and New York Heart Association (NYHA) functional class I to II heart failure (HF).
BACKGROUND: In patients with advanced HF, CRT improves left ventricular (LV) function and reduces mortality and hospitalizations. Recent data suggest that patients with milder HF also benefit from CRT.
METHODS: A meta-analysis of 5 clinical trials including 4,317 patients with NYHA functional class I/II HF was performed.
RESULTS: Average age of patients was 65 years, and 80% were male. Frequency of all-cause mortality for CRT versus ICD was 8% versus 11.5% (risk ratio [RR]: 0.81; 95% confidence interval [CI]: 0.65 to 0.99, p = 0.04); for HF hospitalization, it was 11.6% versus 18.2% (RR: 0.68; 95% CI: 0.59 to 0.79, p < 0.001). Patients assigned to CRT had a significantly greater improvement in LVEF (+5.9% vs. +2.2%, p < 0.001) and LV volume than ICD patients. Among mildly symptomatic (NYHA functional class II) patients, CRT was associated with significantly lower mortality and HF hospitalization (RR: 0.73; 95% CI: 0.64 to 0.83), p < 0.001). In asymptomatic (NYHA functional class I) patients, HF hospitalization risk was lower (RR: 0.57; 95% CI: 0.34 to 0.97, p = 0.04) with CRT; however, there was no…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,317 participants or records.
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