De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis
| Autor: | Endre Zima, Klaudia Vivien Nagy, Mate Vamos, Annamaria Kosztin, W R Schwertner, László Gellér, Valentina Kutyifa, Béla Merkely, Daniel Aradi, Attila Kovács, Gabor Z. Duray |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Cardiac resynchronization therapy 030204 cardiovascular system & hematology De novo CRT Nyha class Ventricular Function Left Article Cardiac Resynchronization Therapy 03 medical and health sciences QRS complex 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Mortality Heart Failure Ejection fraction business.industry medicine.disease Clinical trial CRT upgrade Upgrade Treatment Outcome Meta-analysis Heart failure Meta-analyses Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart Failure Reviews |
| ISSN: | 1573-7322 |
| Popis: | Patients with conventional pacemakers or implanted defibrillators are often considered for cardiac resynchronization therapy (CRT). Our aim was to summarize the available evidences regarding the clinical benefits of upgrade procedures. A systematic literature search was performed from studies published between 2006 and 2017 in order to compare the outcome of CRT upgrade vs. de novo implantations. Outcome data on all-cause mortality, heart failure events, New York Heart Association (NYHA) Class, QRS narrowing and echocardiographic parameters were analysed. A total of 16 reports were analysed comprising 489,568 CRT recipients, of whom 468,205 patients underwent de novo and 21,363 upgrade procedures. All-cause mortality was similar after CRT upgrade compared to de novo implantations (RR 1.19, 95% CI 0.88–1.60, p = 0.27). The risk of heart failure was also similar in both groups (RR 0.96, 95% CI 0.70–1.32, p = 0.81). There was no significant difference in clinical response after CRT upgrade compared to de novo implantations in terms of improvement in left ventricular ejection fraction (ΔEF de novo − 6.85% vs. upgrade − 9.35%; p = 0.235), NYHA class (ΔNYHA de novo − 0.74 vs. upgrade − 0.70; p = 0.737) and QRS narrowing (ΔQRS de novo − 9.6 ms vs. upgrade − 29.5 ms; p = 0.485). Our systematic review and meta-analysis of currently available studies reports that CRT upgrade is associated with similar risk for all-cause mortality compared to de novo resynchronization therapy. Benefits on reverse remodelling and functional capacity improved similarly in both groups suggesting that CRT upgrade may be safely and effectively offered in routine practice. Clinical Trial Registration: Prospero Database—CRD42016043747 Electronic supplementary material The online version of this article (10.1007/s10741-017-9652-1) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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