PMID- 21594629
OWN - NLM
STAT- MEDLINE
DCOM- 20120322
LR  - 20211020
IS  - 1572-8595 (Electronic)
IS  - 1383-875X (Linking)
VI  - 32
IP  - 2
DP  - 2011 Nov
TI  - Cardiac resynchronization therapy in patients with mild heart failure: a 
      systematic review and meta-analysis.
PG  - 125-35
LID - 10.1007/s10840-011-9584-y [doi]
AB  - PURPOSE: Cardiac resynchronization therapy (CRT) reduces symptoms and improves 
      survival in patients with advanced heart failure (New York Heart Association 
      (NYHA) functional class III-IV), reduced ejection fraction, and wide QRS complex. 
      Whether CRT has the same benefit also in asymptomatic or mildly symptomatic heart 
      failure patients is controversial. Our objective is to summarize the available 
      evidence on the effects of CRT in asymptomatic or mildly symptomatic (NYHA I-II) 
      heart failure patients. METHODS: We searched major web databases for randomized 
      controlled trials of CRT in patients with mild heart failure (NYHA functional 
      class I-II). Data regarding all-cause mortality, heart failure events, left 
      ventricular (LV) volumes and ejection fraction, and worsening of NYHA functional 
      class were extracted. RESULTS: We identified five trials (CONTAK-CD, MIRACLE 
      ICD-II, REVERSE, MADIT-CRT, and RAFT) that enrolled 4,213 patients (91% with NYHA 
      II functional class). Primary analysis excluded the CONTAK-CD, which was not 
      specifically conducted on patients with mild heart failure. At pooled analysis, 
      CRT decreased mortality (odds ratio (OR), 0.78 [95% confidence interval (CI)], 
      0.63 to 0.97; p = 0.024) and heart failure events (OR, 0.63 [95% CI, 0.52 to 
      0.76], p < 0.001), induced a significant LV reverse remodeling (weighted mean 
      difference (WMD) of LV ejection fraction [Formula: see text], p = 0.015 and WMD 
      of LV end-systolic volume index [Formula: see text], p < 0.001) and prevented the 
      progression of heart failure symptoms (OR for worsening of NYHA functional class 
      = 0.54 [95% CI, 0.31 to 0.93], p = 0.026). Inclusion of the CONTAK-CD did not 
      change the results. CONCLUSIONS: Among patients with mild (NYHA II) heart 
      failure, CRT reduces mortality and the risk of heart failure events, induces a 
      favorable LV reverse remodeling and slows the progression of heart failure 
      symptoms.
FAU - Santangeli, Pasquale
AU  - Santangeli P
AD  - Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA. 
      pasquale.santangeli@libero.it
FAU - Di Biase, Luigi
AU  - Di Biase L
FAU - Pelargonio, Gemma
AU  - Pelargonio G
FAU - Dello Russo, Antonio
AU  - Dello Russo A
FAU - Casella, Michela
AU  - Casella M
FAU - Bartoletti, Stefano
AU  - Bartoletti S
FAU - Burkhardt, J David
AU  - Burkhardt JD
FAU - Mohanty, Prasant
AU  - Mohanty P
FAU - Santarelli, Pietro
AU  - Santarelli P
FAU - Natale, Andrea
AU  - Natale A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20110519
PL  - Netherlands
TA  - J Interv Card Electrophysiol
JT  - Journal of interventional cardiac electrophysiology : an international journal of 
      arrhythmias and pacing
JID - 9708966
SB  - IM
MH  - Cardiac Resynchronization Therapy/*methods
MH  - Disease Progression
MH  - Electrocardiography/methods
MH  - Exercise Tolerance/physiology
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/diagnosis/*mortality/*therapy
MH  - Heart Function Tests
MH  - Humans
MH  - Male
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Stroke Volume/*physiology
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - United States
MH  - Ventricular Remodeling/physiology
EDAT- 2011/05/20 06:00
MHDA- 2012/03/23 06:00
CRDT- 2011/05/20 06:00
PHST- 2011/03/07 00:00 [received]
PHST- 2011/04/20 00:00 [accepted]
PHST- 2011/05/20 06:00 [entrez]
PHST- 2011/05/20 06:00 [pubmed]
PHST- 2012/03/23 06:00 [medline]
AID - 10.1007/s10840-011-9584-y [doi]
PST - ppublish
SO  - J Interv Card Electrophysiol. 2011 Nov;32(2):125-35. doi: 
      10.1007/s10840-011-9584-y. Epub 2011 May 19.