Left ventricular contractile reserve by stress echocardiography as a predictor of response to cardiac resynchronization therapy in heart failure: a systematic review and meta-analysis

BMC Cardiovascular Disorders

Research Article

Claudio Michelassi¹  Clara Carpeggiani¹  Eugenio Picano¹  Bruno Villari²  Quirino Ciampi² 

[1] CNR, Institute of Clinical Physiology, Pisa, Italy;Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli, 12, I-82100, Benevento, Italy;

关键词: Cardiac resynchronization therapy;    Contractile reserve;    Stress echo;    Heart failure;   

DOI  :  10.1186/s12872-017-0657-4

 received in 2017-04-17, accepted in 2017-08-06,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017