TY - JOUR
T1 - The role of guidance in delivering cardiac resynchronization therapy
T2 - A systematic review and network meta-analysis
AU - Mehta, Vishal S.
AU - Ayis, Salma
AU - Elliott, Mark K.
AU - Widjesuriya, Nadeev
AU - Kardaman, Nuha
AU - Gould, Justin
AU - Behar, Jonathan M.
AU - Chiribiri, Amedeo
AU - Razavi, Reza
AU - Niederer, Steven
AU - Rinaldi, Christopher A.
N1 - Funding Information:
The study was supported by the Wellcome Wellcome / EPSRC Centre for Medical Engineering (WT203148/Z/16/Z).
Funding Information:
The department is supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z). M.K.E., V.S.M., and J.G. have received fellowship funding from Abbott. C.A.R. receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics, and MicroPort outside of the submitted work. S.A. was funded/supported by the NIHR Biomedical Research Centre based at GSTT and KCL. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.
Funding Information:
The study was supported by the WellcomeWellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z). The department is supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z). M.K.E. V.S.M. and J.G. have received fellowship funding from Abbott. C.A.R. receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics, and MicroPort outside of the submitted work. S.A. was funded/supported by the NIHR Biomedical Research Centre based at GSTT and KCL. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. All authors attest they meet the current ICMJE criteria for authorship. The database collection and analysis were approved by the Institutional Review Board of Guy's and St Thomas’ Hospital. The research in this study was conducted in accordance with the Declaration of Helsinki. The research reported herein adhered to relevant ethical guidelines and the authors are in compliance with the regulations of their institutional review boards on human studies and animal care and use committees, including obtaining patient consent where appropriate.
Publisher Copyright:
© 2022 Heart Rhythm Society
PY - 2022/10
Y1 - 2022/10
N2 - Background: Positioning the left ventricular lead at the optimal myocardial segment has been proposed to improve cardiac resynchronization therapy (CRT) response. Objectives: We performed a systematic review and network meta-analysis evaluating echocardiographic and clinical response delivered with different guidance modalities compared to conventional fluoroscopic positioning. Methods: Randomized trials with ≥6 months follow-up comparing any combination of imaging, electrical, hemodynamic, or fluoroscopic guidance were included. Imaging modalities were split whether one modality was used: cardiac magnetic resonance (CMR), speckle-tracking echocardiography (STE), single-photon emission computed tomography, cardiac computed tomography (CT), or a combination of these, defined as “multimodality imaging.” Results: Twelve studies were included (n = 1864). Pair-wise meta-analysis resulted in significant odds of reduction in left ventricular end-systolic volume (LVESV) >15% (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.05–2.13, P = .025) and absolute reduction in LVESV (standardized mean difference [SMD] -0.25, 95% CI -0.43 to -0.08, P = .005) with guidance. CMR (OR 55.3, 95% CI 4.7–656.9, P = .002), electrical (OR 17.0, 95% CI 2.9–100, P = .002), multimodality imaging (OR 4.47, 95% CI 1.36–14.7, P = .014), and hemodynamic guidance (OR 1.29–28.0, P = .02) were significant in reducing LVESV >15%. Only STE demonstrated a significant reduction in absolute LVESV (SMD -0.38, 95% CI -0.68 to -0.09, P = .011]. CMR had the highest probability of improving clinical response (OR 17.9, 95% CI 5.14–62.5, P < .001). Conclusion: Overall, guidance improves CRT outcomes. STE and multimodality imaging provided the most reliable evidence of efficacy. Wide CIs observed for results of CMR guidance suggest more powered studies are required before a clear ranking is possible.
AB - Background: Positioning the left ventricular lead at the optimal myocardial segment has been proposed to improve cardiac resynchronization therapy (CRT) response. Objectives: We performed a systematic review and network meta-analysis evaluating echocardiographic and clinical response delivered with different guidance modalities compared to conventional fluoroscopic positioning. Methods: Randomized trials with ≥6 months follow-up comparing any combination of imaging, electrical, hemodynamic, or fluoroscopic guidance were included. Imaging modalities were split whether one modality was used: cardiac magnetic resonance (CMR), speckle-tracking echocardiography (STE), single-photon emission computed tomography, cardiac computed tomography (CT), or a combination of these, defined as “multimodality imaging.” Results: Twelve studies were included (n = 1864). Pair-wise meta-analysis resulted in significant odds of reduction in left ventricular end-systolic volume (LVESV) >15% (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.05–2.13, P = .025) and absolute reduction in LVESV (standardized mean difference [SMD] -0.25, 95% CI -0.43 to -0.08, P = .005) with guidance. CMR (OR 55.3, 95% CI 4.7–656.9, P = .002), electrical (OR 17.0, 95% CI 2.9–100, P = .002), multimodality imaging (OR 4.47, 95% CI 1.36–14.7, P = .014), and hemodynamic guidance (OR 1.29–28.0, P = .02) were significant in reducing LVESV >15%. Only STE demonstrated a significant reduction in absolute LVESV (SMD -0.38, 95% CI -0.68 to -0.09, P = .011]. CMR had the highest probability of improving clinical response (OR 17.9, 95% CI 5.14–62.5, P < .001). Conclusion: Overall, guidance improves CRT outcomes. STE and multimodality imaging provided the most reliable evidence of efficacy. Wide CIs observed for results of CMR guidance suggest more powered studies are required before a clear ranking is possible.
KW - Cardiac resynchronization therapy
KW - Efficacy
KW - Guidance
KW - LV lead
KW - Meta-analysis
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85136250051&partnerID=8YFLogxK
U2 - 10.1016/j.hroo.2022.07.005
DO - 10.1016/j.hroo.2022.07.005
M3 - Article
AN - SCOPUS:85136250051
SN - 2666-5018
VL - 3
SP - 482
EP - 492
JO - Heart Rhythm O2
JF - Heart Rhythm O2
IS - 5
ER -