Key result
Contractile reserve on stress echocardiography is linked to ~8-fold higher odds of CRT response.
Why the study?
Up to one-third of patients receiving CRT do not fully benefit, and contractile reserve by stress echocardiography may predict CRT response.
Does the presence of contractile reserve by stress echocardiography predict positive response to CRT in heart failure patients?
Meta-Analysis (n=1,399)
Does the presence of contractile reserve by stress echocardiography predict positive response to CRT in heart failure patients?
The presence of contractile reserve during stress echocardiography strongly predicts a positive response to cardiac resynchronization therapy in heart failure patients.
Answers are grounded in this paper and cite their sources.
May aid CRT responder selection in HF; confirms predictive association but requires prospective validation.
Introduction: Up to one-third of patients who received resynchronization devices do not experience full benefit of cardiac resynchronization therapy (CRT). Echocardiography plays an important role in heart failure patients treated with CRT. Contractile reserved is a strong prognostic factor to predict positive response to CRT (CRT responder). Objective: We perform a systematic review and meta-analysis of published data to assess the relationship between contractile reserve (CR) and response to CRT. Methods: We conduct a systematic search from major medical databases on all clinical trials published up to June 2020, written in English, full-text availability, and human subject. We used Newcastle-Ottawa Scale to measure the quality of evidence. We employed the Mantel–Haenszel random-effects meta-analysis of using RevMan 5.4. Results: We identified 17 studies involving 1399 patients. The type of stress was either dobutamine (n=15) or exercise (n=2). The presence of CR was associated with a higher chance of CRT responder (OR 7.68, 95%CI 4.27–13.82, p<0.001) using a random-effects model. The ORs slightly differed when studies were analyzed separately based on the stress test type and definition of CR. Contractile reserve, assessed with dobutamine stress echocardiography (DSE), defined as an increase in LVEF (OR 5.10, 95% CI 2.29–11.32, P <0.00001) was numerically lower than defined as increased LV contractility (OR 6.86, 95% CI 3.36–12.88, P <0.00001). The presence of CR assessed with exercise stress test are associated with higher chance of CRT responder (OR 49.11, 95% CI 15.04–160.36, P <0.00001). From our meta-analysis, we found non-ischemic has better respond to CRT compare to patient with ischemic etiology (OR 0.41; 95% CI 0.31-0.55, P <0.01). Conclusion: The presence of CR during stress test echocardiography with either dobutamine or exercise stress test is associated with a higher chance of CRT responder.
No takes yet. Share an insight, caveat, or question.
Lefi et al. (2021) conducted a meta-analysis in Heart failure with indications for cardiac resynchronization therapy (n=1,399). Contractile reserve assessed by stress test echocardiography vs. Absence of contractile reserve was evaluated on Positive response to cardiac resynchronization therapy (CRT responder) (OR 7.68, 95% CI 4.27-13.82, p=<0.001). The presence of contractile reserve during stress test echocardiography was associated with a significantly higher chance of being a cardiac resynchronization therapy responder (OR 7.68).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: