PMID- 20447580
OWN - NLM
STAT- MEDLINE
DCOM- 20110602
LR  - 20100507
IS  - 1532-8414 (Electronic)
IS  - 1071-9164 (Linking)
VI  - 16
IP  - 5
DP  - 2010 May
TI  - Extending the boundaries of cardiac resynchronization therapy: efficacy in atrial 
      fibrillation, New York heart association class II, and narrow QRS heart failure 
      patients.
PG  - 432-8
LID - 10.1016/j.cardfail.2009.12.018 [doi]
AB  - BACKGROUND: Large-scale clinical trials have demonstrated the benefits of cardiac 
      resynchronization therapy (CRT) in patients with New York Heart Association 
      (NYHA) Class III/IV heart failure, systolic left ventricular dysfunction, and a 
      wide QRS. However, additional patient groups may also benefit from CRT. METHODS 
      AND RESULTS: We meta-analyzed clinical benefits of CRT in heart failure patients 
      with narrow QRS, atrial fibrillation (AF) and NYHA Class II symptoms. Thirteen 
      trials of 2882 patients contributed to this meta-analysis. In the narrow versus 
      wide QRS group comparison, no difference in benefit was observed for change in 
      left ventricular ejection fraction (standardized mean difference [SMD] 0.30, 95% 
      confidence interval [CI] -0.37 to 0.97) or left ventricular end systolic volume 
      (SMD 0.30, 95% CI -1.14 to 1.74). The benefit was greater in the wide QRS group 
      for the 6-minute walk test (SMD 1.27, 95% CI 0.59 to 1.96) and NYHA class 
      improvement (SMD 1.24, 95% CI 0.72 to 1.75). In the atrial fibrillation (AF) 
      versus sinus rhythm (SR) group comparison, no difference in benefit was observed 
      for change in left ventricular ejection fraction (SMD -0.38, 95% CI -1.28 to 
      0.53) or NYHA improvement (SMD 0.32, 95% CI -0.77 to 1.40). In the NYHA II versus 
      NYHA III/IV group comparison, no difference in benefit was observed for change in 
      left ventricular end diastolic diameter (SMD 0.05, 95% CI -0.94 to 1.05) or left 
      ventricular end systolic diameter (SMD 0.74, 95% CI -1.98 to 3.46). CONCLUSIONS: 
      Large-scale clinical outcome trials of CRT are warranted in heart failure 
      patients with narrow QRS, AF, and NYHA II, given the similar benefits observed to 
      those with wide QRS, SR, and NYHA III/IV for many parameters.
FAU - Wein, Sara
AU  - Wein S
AD  - Alfred Hospital, Melbourne, Australia.
FAU - Voskoboinik, Aleksandr
AU  - Voskoboinik A
FAU - Wein, Lironne
AU  - Wein L
FAU - Billah, Baki
AU  - Billah B
FAU - Krum, Henry
AU  - Krum H
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20100211
PL  - United States
TA  - J Card Fail
JT  - Journal of cardiac failure
JID - 9442138
SB  - IM
MH  - Atrial Fibrillation/pathology/*therapy
MH  - *Cardiac Pacing, Artificial
MH  - Confidence Intervals
MH  - Exercise Test
MH  - Exercise Tolerance
MH  - Heart Failure/pathology/*therapy
MH  - Humans
MH  - Stroke Volume
MH  - Ventricular Dysfunction, Left/therapy
MH  - Ventricular Function, Left
EDAT- 2010/05/08 06:00
MHDA- 2011/06/03 06:00
CRDT- 2010/05/08 06:00
PHST- 2009/08/06 00:00 [received]
PHST- 2009/11/07 00:00 [revised]
PHST- 2009/12/21 00:00 [accepted]
PHST- 2010/05/08 06:00 [entrez]
PHST- 2010/05/08 06:00 [pubmed]
PHST- 2011/06/03 06:00 [medline]
AID - S1071-9164(09)01238-X [pii]
AID - 10.1016/j.cardfail.2009.12.018 [doi]
PST - ppublish
SO  - J Card Fail. 2010 May;16(5):432-8. doi: 10.1016/j.cardfail.2009.12.018. Epub 2010 
      Feb 11.