Cardiac resynchronization therapy in patients with minimal heart failure: A systematic review and meta-analysis

Selcuk Adabag; Henri Roukoz; Inder S. Anand; Arthur J. Moss

doi:10.1016/j.jacc.2011.05.022

Cardiac resynchronization therapy in patients with minimal heart failure: A systematic review and meta-analysis

Selcuk Adabag
, Henri Roukoz
, Inder S. Anand
, Arthur J. Moss

Research output: Contribution to journal › Article › peer-review

67 Scopus citations

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 difference in mortality. Twelve asymptomatic HF patients needed to be treated with CRT to prevent 1 hospitalization. Conclusions: Cardiac resynchronization therapy decreases all-cause mortality, reduces HF hospitalizations, and improves LVEF in NYHA functional class I/II HF patients. Although there was a reduction in HF hospitalization with CRT for asymptomatic (NYHA functional class I) patients, risks versus benefits have to be carefully considered in this subgroup.

Original language	English (US)
Pages (from-to)	935-941
Number of pages	7
Journal	Journal of the American College of Cardiology
Volume	58
Issue number	9
DOIs	https://doi.org/10.1016/j.jacc.2011.05.022
State	Published - Aug 23 2011

Bibliographical note

Funding Information:
This project was funded by a physician-initiated research grant from Boston Scientific Corporation , Arden Hills , Minnesota . Dr. Moss reports receiving a research grant from Boston Scientific to the University of Rochester in support of the MADIT clinical trials. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Clinical Research Cardiac Resynchronization Therapy

Keywords

cardiac resynchronization therapy
heart failure
hospitalization
meta-analysis
mortality

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10.1016/j.jacc.2011.05.022

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title = "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 difference in mortality. Twelve asymptomatic HF patients needed to be treated with CRT to prevent 1 hospitalization. Conclusions: Cardiac resynchronization therapy decreases all-cause mortality, reduces HF hospitalizations, and improves LVEF in NYHA functional class I/II HF patients. Although there was a reduction in HF hospitalization with CRT for asymptomatic (NYHA functional class I) patients, risks versus benefits have to be carefully considered in this subgroup.",

keywords = "cardiac resynchronization therapy, heart failure, hospitalization, meta-analysis, mortality",

author = "Selcuk Adabag and Henri Roukoz and Anand, \{Inder S.\} and Moss, \{Arthur J.\}",

note = "Funding Information: This project was funded by a physician-initiated research grant from Boston Scientific Corporation , Arden Hills , Minnesota . Dr. Moss reports receiving a research grant from Boston Scientific to the University of Rochester in support of the MADIT clinical trials. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Clinical Research Cardiac Resynchronization Therapy ",

year = "2011",

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doi = "10.1016/j.jacc.2011.05.022",

language = "English (US)",

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T2 - A systematic review and meta-analysis

AU - Adabag, Selcuk

AU - Roukoz, Henri

AU - Anand, Inder S.

AU - Moss, Arthur J.

N1 - Funding Information: This project was funded by a physician-initiated research grant from Boston Scientific Corporation , Arden Hills , Minnesota . Dr. Moss reports receiving a research grant from Boston Scientific to the University of Rochester in support of the MADIT clinical trials. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Clinical Research Cardiac Resynchronization Therapy

PY - 2011/8/23

Y1 - 2011/8/23

N2 - 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 difference in mortality. Twelve asymptomatic HF patients needed to be treated with CRT to prevent 1 hospitalization. Conclusions: Cardiac resynchronization therapy decreases all-cause mortality, reduces HF hospitalizations, and improves LVEF in NYHA functional class I/II HF patients. Although there was a reduction in HF hospitalization with CRT for asymptomatic (NYHA functional class I) patients, risks versus benefits have to be carefully considered in this subgroup.

AB - 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 difference in mortality. Twelve asymptomatic HF patients needed to be treated with CRT to prevent 1 hospitalization. Conclusions: Cardiac resynchronization therapy decreases all-cause mortality, reduces HF hospitalizations, and improves LVEF in NYHA functional class I/II HF patients. Although there was a reduction in HF hospitalization with CRT for asymptomatic (NYHA functional class I) patients, risks versus benefits have to be carefully considered in this subgroup.

KW - cardiac resynchronization therapy

KW - heart failure

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Cardiac resynchronization therapy in patients with minimal heart failure: A systematic review and meta-analysis

Abstract

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