PMID- 21851882
OWN - NLM
STAT- MEDLINE
DCOM- 20111013
LR  - 20181201
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 58
IP  - 9
DP  - 2011 Aug 23
TI  - Cardiac resynchronization therapy in patients with minimal heart failure: a 
      systematic review and meta-analysis.
PG  - 935-41
LID - 10.1016/j.jacc.2011.05.022 [doi]
AB  - OBJECTIVES: The purpose of this study was to perform a systematic review and 
      meta-analysis of prospective randomized clinical trials of cardiac 
      resynchronization therapy (CRT) versus implantable cardioverter-defibrillator 
      (ICD) in patients with reduced ejection fraction (EF), prolonged QRS interval, 
      and New York Heart Association (NYHA) functional class I to II heart failure 
      (HF). BACKGROUND: In patients with advanced HF, CRT improves left ventricular 
      (LV) function and reduces mortality and hospitalizations. Recent data suggest 
      that patients with milder HF also benefit from CRT. METHODS: A meta-analysis of 5 
      clinical trials including 4,317 patients with NYHA functional class I/II HF was 
      performed. RESULTS: Average age of patients was 65 years, and 80% were male. 
      Frequency of all-cause mortality for CRT versus ICD was 8% versus 11.5% (risk 
      ratio [RR]: 0.81; 95% confidence interval [CI]: 0.65 to 0.99, p = 0.04); for HF 
      hospitalization, it was 11.6% versus 18.2% (RR: 0.68; 95% CI: 0.59 to 0.79, p < 
      0.001). Patients assigned to CRT had a significantly greater improvement in LVEF 
      (+5.9% vs. +2.2%, p < 0.001) and LV volume than ICD patients. Among mildly 
      symptomatic (NYHA functional class II) patients, CRT was associated with 
      significantly lower mortality and HF hospitalization (RR: 0.73; 95% CI: 0.64 to 
      0.83), p < 0.001). In asymptomatic (NYHA functional class I) patients, HF 
      hospitalization risk was lower (RR: 0.57; 95% CI: 0.34 to 0.97, p = 0.04) with 
      CRT; however, there was no difference in mortality. Twelve asymptomatic HF 
      patients needed to be treated with CRT to prevent 1 hospitalization. CONCLUSIONS: 
      Cardiac resynchronization therapy decreases all-cause mortality, reduces HF 
      hospitalizations, and improves LVEF in NYHA functional class I/II HF patients. 
      Although there was a reduction in HF hospitalization with CRT for asymptomatic 
      (NYHA functional class I) patients, risks versus benefits have to be carefully 
      considered in this subgroup.
CI  - Copyright (c) 2011 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Adabag, Selcuk
AU  - Adabag S
AD  - Division of Cardiology, Veterans Administration Medical Center, and University of 
      Minnesota, Minneapolis, Minnesota, USA. adaba001@umn.edu
FAU - Roukoz, Henri
AU  - Roukoz H
FAU - Anand, Inder S
AU  - Anand IS
FAU - Moss, Arthur J
AU  - Moss AJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - Aged
MH  - *Cardiac Resynchronization Therapy/methods/trends
MH  - Female
MH  - Heart Failure/diagnosis/*mortality/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Randomized Controlled Trials as Topic/*methods/trends
EDAT- 2011/08/20 06:00
MHDA- 2011/10/14 06:00
CRDT- 2011/08/20 06:00
PHST- 2011/03/09 00:00 [received]
PHST- 2011/05/17 00:00 [revised]
PHST- 2011/05/24 00:00 [accepted]
PHST- 2011/08/20 06:00 [entrez]
PHST- 2011/08/20 06:00 [pubmed]
PHST- 2011/10/14 06:00 [medline]
AID - S0735-1097(11)02051-1 [pii]
AID - 10.1016/j.jacc.2011.05.022 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2011 Aug 23;58(9):935-41. doi: 10.1016/j.jacc.2011.05.022.