Key result
The presence of contractile reserve after dobutamine infusion was associated with a higher chance of response to cardiac resynchronization therapy (OR 4.42; 95% CI 2.15-9.07; P<0.001).
Why the study?
Does the presence of myocardial contractile reserve predict response to cardiac resynchronization therapy in patients with heart failure?
Meta-Analysis (n=757)
Does the presence of myocardial contractile reserve predict response to cardiac resynchronization therapy in patients with heart failure?
The presence of global contractile reserve at baseline, assessed by dobutamine stress echocardiography, significantly predicts a higher likelihood of response to CRT in heart failure patients.
Answers are grounded in this paper and cite their sources.
May aid CRT response prediction in HF; leaves open its use for patient selection pending prospective validation.
AIM: To perform a meta-analysis and systematic review of published data to assess the relationship between contractile reserve and response to cardiac resynchronization therapy (CRT) in patients with heart failure. METHODS AND RESULTS: We searched MEDLINE/PubMed and Cochrane for all papers published up to 26 April 2016, supplemented by manual searches of reference lists from retrieved articles. The search strategy yielded nine observational studies that met our eligibility criteria with a total of 767 patients of which 757 provided data for this analysis. Contractile reserve after dobutamine infusion was present in 496 patients (66%). During follow-up 474 patients (63%) qualified as CRT responders. The presence of contractile reserve was associated with a higher chance of CRT response (odds ratio 4.42, 95% confidence interval 2.15-9.07, P < 0.001) using a random-effects model. There was evidence of publication bias. Imputation of missing studies attenuated the association to some extent, but the positive association between contractile reserve and CRT response remained with an odds ratio of 2.42 (95% confidence interval 1.17-5.05, P = 0.018). CONCLUSION: The presence of global contractile reserve at baseline, as assessed by dobutamine stress echocardiography, is associated with a higher chance of CRT response in patients with heart failure.
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Kloosterman et al. (2017) conducted a meta-analysis in heart failure (n=757). Contractile reserve vs. Absence of contractile reserve was evaluated on CRT response (OR 4.42, 95% CI 2.15-9.07, p=<0.001). The presence of contractile reserve after dobutamine infusion was associated with a higher chance of response to cardiac resynchronization therapy (OR 4.42; 95% CI 2.15-9.07; P<0.001).
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