Abstract 14094: Is Optimization of Cardiac Resynchronization Therapy in Patients With Heart Failure Worth the Effort? A Meta-Analysis of Effects on Left Ventricular Function, Exercise Capacity and Quality of Life
Background: Cardiac resynchronization therapy (CRT) has been shown to improve left ventricular (LV) functional and structural remodeling, symptoms and functional status in heart failure (HF). The contribution of post-implant optimization of CRT device settings to this beneficial effect is still uncertain. We performed a meta-analysis to investigate the impact of CRT optimization on the improvement of LV function, exercise capacity and quality of life in pts with HF.
Methods: We searched relevant randomized, controlled clinical and observational studies in the Medline and Embase databases using the keywords optimization, exercise, ejection fraction, cardiac function, quality of life, biventricular pacing and CRT. Weighted mean difference (WMD) with 95% CI for changes in LV ejection fraction, 6 min walk distance and Minnesota Living with Heart Failure quality-of-life score at follow up were assessed using a random effects model.
Results: 11 trials enrolling 740 patients (528 optimized and 212 non-optimized) were identified. Pooled analysis demonstrated that the optimization procedure resulted in a significant increase in LV ejection fraction (WMD 4.3%, 95%CI 4.1-4.5, p<0.001) as compared to a non-optimized CRT. No improvements with the optimization of CRT were seen in 6 min walk distance (WMD 2 m, 95%CI -9-13, p=0.86) and quality of life (MWD 1.1, 95%CI -0.6-2.7, p=0.51), however data for this part of analysis was achievable only in 3 reports.
Conclusions: The results of prior studies evaluating the effects of the optimization of CRT in heart failure are not conclusive for all parameters. Collated data suggests a significant improvement in LV ejection fraction, however additional, adequately powered randomized trials are needed to verify potential benefits of this procedure.
- © 2013 by American Heart Association, Inc.