Comparative efficacy of image-guided techniques in cardiac resynchronization therapy: a meta-analysis

BMC Cardiovascular Disorders

Hai Xu¹  Zhiyong Qian²  Xiaofeng Hou²  Shameer Raaj Avishkar Hassea²  Jiangang Zou²  Yao Wang²  Xinwei Zhang²  Xiao Hu³ 

[1] Department of Cardiology, Staten Island University Hospital / Northwell Health, 475 Seaview Drive, 10305, Staten Island, NY, USA;Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, 210029, Nanjing, China;Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, 210029, Nanjing, China;Department of Cardiology, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China;

关键词: Cardiac resynchronization therapy;    Image-guided;    CRT response;    Heart failure;   

DOI  :  10.1186/s12872-021-02061-y

来源: Springer

【 摘 要 】

BackgroundSeveral studies have illustrated the use of echocardiography, magnetic resonance imaging, and nuclear imaging to optimize left ventricular (LV) lead placement to enhance the response of cardiac resynchronization therapy (CRT) in heart failure patients. We aimed to conduct a meta-analysis to determine the incremental efficacy of image-guided CRT over standard CRT.MethodsWe searched PubMed, Cochrane library, and EMBASE to identify relevant studies. The outcome measures of cardiac function and clinical outcomes were CRT response, concordance of the LV lead to the latest sites of contraction (concordance of LV), heart failure (HF) hospitalization, mortality rates, changes of left ventricular ejection fraction (LVEF), and left ventricular end-systolic volume (LVESV).ResultsThe study population comprised 1075 patients from eight studies. 544 patients underwent image-guided CRT implantation and 531 underwent routine implantation without imaging guidance. The image-guided group had a significantly higher CRT response and more on-target LV lead placement than the control group (RR, 1.33 [95% CI, 1.21 to 1.47]; p < 0.01 and RR, 1.39 [95% CI, 1.01 to 1.92]; p < 0.05, respectively). The reduction of LVESV in the image-guided group was significantly greater than that in the control group (weighted mean difference, − 12.46 [95% CI, − 18.89 to − 6.03]; p < 0.01). The improvement in LVEF was significantly higher in the image-guided group (weighted mean difference, 3.25 [95% CI, 1.80 to 4.70]; p < 0.01). Pooled data demonstrated no significant difference in HF hospitalization and mortality rates between two groups (RR, 0.89 [95% CI, 0.16 to 5.08]; p = 0.90, RR, 0.69 [95% CI, 0.37 to 1.29]; p = 0.24, respectively).ConclusionsThis meta-analysis indicates that image-guided CRT is correlated with improved CRT volumetric response and cardiac function in heart failure patients but not with lower hospitalization or mortality rate.

【 授权许可】

CC BY