Cardiac Resynchronization Therapy With or Without Defibrillation in Patients With Nonischemic Cardiomyopathy: A Systematic Review and Meta-Analysis

DOI Web Site 被引用文献1件
  • Divyang Patel
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • Anirudh Kumar
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • Eric Black-Maier
    Duke Clinical Research Institute, Duke University Medical System, Durham, NC (E.B.-M., S.M.A.-K.).
  • Rebecca L. Morgan
    Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada (R.L.M.).
  • Kevin Trulock
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • Bryan Wilner
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • David Nemer
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • Eoin Donnellan
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • Khaldoun G. Tarakji
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • Daniel J. Cantillon
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • Niraj Varma
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • Samir F. Saba
    The Heart and Vascular Institute, Department of Medicine, University of Pittsburgh Medical Center, PA (S.F.S.).
  • Sana M. Al-Khatib
    Duke Clinical Research Institute, Duke University Medical System, Durham, NC (E.B.-M., S.M.A.-K.).
  • Bruce L. Wilkoff
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).
  • John W. Rickard
    Heart and Vascular Institute Cleveland Clinic, OH (D.P., A.K., K.T., B.W., D.N., E.D., K.G.T., D.J.C., N.V., B.L.W., J.W.R.).

抄録

<jats:sec> <jats:title>Background:</jats:title> <jats:p>Cardiac resynchronization therapy (CRT) represents a major medical advance in patients with heart failure with electrical dyssynchrony to improve symptoms, reduce hospitalization, and increase survival both in the presence and absence of implantable cardioverter-defibrillator therapy. However, among CRT-eligible patients with nonischemic cardiomyopathy (NICM), the benefit of defibrillator therapy in addition to CRT remains unclear. A systematic review and meta-analysis comparing outcomes of patients with NICM and heart failure who underwent CRT with implantable cardioverter-defibrillator (CRT-D) versus CRT-pacemaker only (CRT-P) was, therefore, performed.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>A literature search from inception through February 2020 was conducted in PubMed and Cochrane Review Databases for all studies reporting outcomes of CRT-D versus CRT-P in CRT-eligible patients with NICM. Studies reporting nonstratified outcomes, including patients with ischemic cardiomyopathy, were excluded. The primary end point of interest was all-cause mortality. A random-effects model using hazards ratio (HR) was used to calculate a cumulative HR for all-cause mortality. The Grading of Recommendations Assessment, Development, and Evaluation approach assessed the certainty of evidence across outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> Of a total of 1478 potential citations, the search yielded 8 citations that met inclusion and exclusion criteria. There was one randomized controlled trial which included a subgroup of 645 CRT-eligible patients with NICM (322 with CRT-D and 323 with CRT-P). Seven observational studies representing 9944 CRT-eligible patients with NICM (6865 CRT-D implantation and 3079 with CRT-P) were included in a pooled meta-analysis. The cumulative adjusted HR for all-cause mortality for CRT-D versus CRT-P was 0.92 (95% CI, 0.83–1.03); <jats:italic>I</jats:italic> <jats:sup>2</jats:sup> =0 though with low certainty of evidence. There may be little difference in infection and cardiac mortality between CRT-D versus CRT-P devices (HR, 0.82 [95% CI, 0.29–2.20] moderate certainty of evidence and HR, 0.68 [95% CI, 0.37–1.25], low certainty of evidence, respectively). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>In this meta-analysis, the addition of defibrillator therapy was not significantly associated with a reduction in all-cause mortality in CRT-eligible patients with NICM.</jats:p> </jats:sec>

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