Key result
In patients with left ventricular systolic dysfunction, CRT reduced all-cause mortality (OR 0.73; 95% CI 0.60-0.89; p=0.002), as did ICD therapy (OR 0.75; 95% CI 0.59-0.96; p=0.025).
Why the study?
Does CRT, ICD, or both reduce mortality and improve clinical outcomes in patients with left ventricular systolic dysfunction?
Meta-Analysis
Does CRT, ICD, or both reduce mortality and improve clinical outcomes in patients with left ventricular systolic dysfunction?
Odds Ratio: 0.73 (95% CI 0.6–0.89)
p-value: p=0.002
In patients with left ventricular systolic dysfunction, both CRT and ICD therapies significantly reduce all-cause mortality and improve clinical outcomes.
BACKGROUND: The clinical benefits of cardiac resynchronization therapy (CRT) and primary prophylactic implantable cardioverter defibrillator (ICD) in patients with left ventricular systolic dysfunction (LVSD) are debated. OBJECTIVE: To evaluate by a meta-analysis the effect of CRT and prophylactic ICD therapy in patients with LVSD. METHODS: Eligible trials evaluating the effect of CRT vs. no-CRT, ICD vs. no-ICD and adding ICD to CRT vs. no-ICD were selected and meta-analyzed. The outcomes were: all cause mortality, cardiac mortality, hospitalization for heart failure and change in exercise tolerance and New York Heart Association class. RESULTS: Implantation of CRT reduced all cause mortality odds ratio (OR) = 0.73 (0.60-0.89) p = 0.002 and hospitalization for heart failure OR = 0.60 (0.45, 0.80) p = 0.001, increased peak oxygen consumption by 1.77 (0.32-3.22) ml/kg/min p = 0.017 and improved New York Heart Association class by at least one class with OR = 1.52 (1.30, 1.77) p < 0.0001. Implantation of ICD reduced all-cause mortality OR = 0.75 (0.59-0.96) p = 0.025 and cardiac mortality OR = 0.63 (0.48, 0.82) p = 0.001. Adding ICD to CRT reduced all cause mortality OR = 0.69 (0.53-0.91) p = 0.008. CONCLUSION: Selective patients with LVSD benefit from CRT, ICD or both. Further investigations are necessary to clarify which patients benefit most from a single or combined device implantation.
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Abdulla et al. (2006) conducted a meta-analysis in left ventricular systolic dysfunction. Cardiac resynchronization therapy (CRT) and/or implantable cardioverter defibrillator (ICD) vs. No CRT and/or no ICD was evaluated on all cause mortality (OR 0.73, 95% CI 0.60-0.89, p=0.002). In patients with left ventricular systolic dysfunction, CRT reduced all-cause mortality (OR 0.73; 95% CI 0.60-0.89; p=0.002), as did ICD therapy (OR 0.75; 95% CI 0.59-0.96; p=0.025).
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