PMID- 30715300
OWN - NLM
STAT- MEDLINE
DCOM- 20200731
LR  - 20220129
IS  - 2058-1742 (Electronic)
IS  - 2058-5225 (Print)
IS  - 2058-1742 (Linking)
VI  - 5
IP  - 4
DP  - 2019 Oct 1
TI  - Right ventricular pacing for hypertrophic obstructive cardiomyopathy: 
      meta-analysis and meta-regression of clinical trials.
PG  - 321-333
LID - 10.1093/ehjqcco/qcz006 [doi]
AB  - AIMS: Right ventricular pacing for left ventricular outflow tract gradient 
      reduction in hypertrophic obstructive cardiomyopathy remains controversial. We 
      undertook a meta-analysis for echocardiographic and functional outcomes. METHODS 
      AND RESULTS: Thirty-four studies comprising 1135 patients met eligibility 
      criteria. In the four blinded randomized controlled trials (RCTs), pacing reduced 
      gradient by 35% [95% confidence interval (CI) 23.2-46.9, P < 0.0001], but there 
      was only a trend towards improved New York Heart Association (NYHA) class [odds 
      ratio (OR) 1.82, CI 0.96-3.44; P = 0.066]. The unblinded observational studies 
      reported a 54.3% (CI 44.1-64.6, P < 0.0001) reduction in gradient, which was a 
      18.6% greater reduction than the RCTs (P = 0.0351 for difference between study 
      designs). Observational studies reported an effect on unblinded NYHA class at an 
      OR of 8.39 (CI 4.39-16.04, P < 0.0001), 450% larger than the OR in RCTs 
      (P = 0.0042 for difference between study designs). Across all studies, the 
      gradient progressively decreased at longer follow durations, by 5.2% per month 
      (CI 2.5-7.9, P = 0.0001). CONCLUSION: Right ventricular pacing reduces gradient 
      in blinded RCTs. There is a non-significant trend to reduction in NYHA class. The 
      bias in assessment of NYHA class in observational studies appears to be more than 
      twice as large as any genuine treatment effect.
CI  - (c) The Author(s) 2019. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Arnold, Ahran D
AU  - Arnold AD
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Howard, James P
AU  - Howard JP
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Chiew, Kayla
AU  - Chiew K
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Kerrigan, William J
AU  - Kerrigan WJ
AD  - Cardiology Department, Imperial College Healthcare NHS Trust, Du Cane Road, 
      London, UK.
FAU - de Vere, Felicity
AU  - de Vere F
AD  - Cardiology Department, Imperial College Healthcare NHS Trust, Du Cane Road, 
      London, UK.
FAU - Johns, Hannah T
AU  - Johns HT
AD  - University of Melbourne, Burgundy Street, Heidelberg, Victoria, Australia.
FAU - Churlilov, Leonid
AU  - Churlilov L
AD  - University of Melbourne, Burgundy Street, Heidelberg, Victoria, Australia.
FAU - Ahmad, Yousif
AU  - Ahmad Y
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Keene, Daniel
AU  - Keene D
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Shun-Shin, Matthew J
AU  - Shun-Shin MJ
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Cole, Graham D
AU  - Cole GD
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Kanagaratnam, Prapa
AU  - Kanagaratnam P
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Sohaib, S M Afzal
AU  - Sohaib SMA
AD  - Cardiology Department, St Bartholomew's Hospital, W Smithfield, London, UK.
FAU - Varnava, Amanda
AU  - Varnava A
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Francis, Darrel P
AU  - Francis DP
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
FAU - Whinnett, Zachary I
AU  - Whinnett ZI
AD  - National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, 
      Du Cane Road, London, UK.
LA  - eng
GR  - Wellcome Trust/United Kingdom
GR  - CS/15/3/31405/BHF_/British Heart Foundation/United Kingdom
GR  - FS/13/44/30291/BHF_/British Heart Foundation/United Kingdom
GR  - FS/15/53/31615/BHF_/British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J Qual Care Clin Outcomes
JT  - European heart journal. Quality of care & clinical outcomes
JID - 101677796
SB  - IM
CIN - Eur Heart J Qual Care Clin Outcomes. 2019 Oct 1;5(4):281-282. PMID: 30907927
MH  - *Cardiac Pacing, Artificial
MH  - Cardiomyopathy, Hypertrophic/diagnostic imaging/*therapy
MH  - Echocardiography
MH  - Humans
MH  - Randomized Controlled Trials as Topic
PMC - PMC6775860
OTO - NOTNLM
OT  - Hypertrophic cardiomyopathy
OT  - Meta-analysis
OT  - Right ventricular pacing
EDAT- 2019/02/05 06:00
MHDA- 2020/08/01 06:00
PMCR- 2019/01/31
CRDT- 2019/02/05 06:00
PHST- 2018/12/19 00:00 [received]
PHST- 2019/01/25 00:00 [revised]
PHST- 2019/01/31 00:00 [accepted]
PHST- 2019/02/05 06:00 [pubmed]
PHST- 2020/08/01 06:00 [medline]
PHST- 2019/02/05 06:00 [entrez]
PHST- 2019/01/31 00:00 [pmc-release]
AID - 5305037 [pii]
AID - qcz006 [pii]
AID - 10.1093/ehjqcco/qcz006 [doi]
PST - ppublish
SO  - Eur Heart J Qual Care Clin Outcomes. 2019 Oct 1;5(4):321-333. doi: 
      10.1093/ehjqcco/qcz006.