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Review
. 2021 May 24;21(1):255.
doi: 10.1186/s12872-021-02061-y.

Comparative efficacy of image-guided techniques in cardiac resynchronization therapy: a meta-analysis

Xiao Hu  1   2 , Hai Xu  3 , Shameer Raaj Avishkar Hassea  1 , Zhiyong Qian  1 , Yao Wang  1 , Xinwei Zhang  1 , Xiaofeng Hou  1 , Jiangang Zou  4
Affiliations
Review

Comparative efficacy of image-guided techniques in cardiac resynchronization therapy: a meta-analysis

Xiao Hu et al. BMC Cardiovasc Disord. .

Abstract

Background: Several studies have illustrated the use of echocardiography, magnetic resonance imaging, and nuclear imaging to optimize left ventricular (LV) lead placement to enhance the response of cardiac resynchronization therapy (CRT) in heart failure patients. We aimed to conduct a meta-analysis to determine the incremental efficacy of image-guided CRT over standard CRT.

Methods: We searched PubMed, Cochrane library, and EMBASE to identify relevant studies. The outcome measures of cardiac function and clinical outcomes were CRT response, concordance of the LV lead to the latest sites of contraction (concordance of LV), heart failure (HF) hospitalization, mortality rates, changes of left ventricular ejection fraction (LVEF), and left ventricular end-systolic volume (LVESV).

Results: The study population comprised 1075 patients from eight studies. 544 patients underwent image-guided CRT implantation and 531 underwent routine implantation without imaging guidance. The image-guided group had a significantly higher CRT response and more on-target LV lead placement than the control group (RR, 1.33 [95% CI, 1.21 to 1.47]; p < 0.01 and RR, 1.39 [95% CI, 1.01 to 1.92]; p < 0.05, respectively). The reduction of LVESV in the image-guided group was significantly greater than that in the control group (weighted mean difference, - 12.46 [95% CI, - 18.89 to - 6.03]; p < 0.01). The improvement in LVEF was significantly higher in the image-guided group (weighted mean difference, 3.25 [95% CI, 1.80 to 4.70]; p < 0.01). Pooled data demonstrated no significant difference in HF hospitalization and mortality rates between two groups (RR, 0.89 [95% CI, 0.16 to 5.08]; p = 0.90, RR, 0.69 [95% CI, 0.37 to 1.29]; p = 0.24, respectively).

Conclusions: This meta-analysis indicates that image-guided CRT is correlated with improved CRT volumetric response and cardiac function in heart failure patients but not with lower hospitalization or mortality rate.

Keywords: CRT response; Cardiac resynchronization therapy; Heart failure; Image-guided.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for study selection
Fig. 2
Fig. 2
Forest plot of CRT response between groups. A fixed-effects model and Mantel–Haenszel method were used to pool data. Abbreviations: CI, confidence interval; CRT, Cardiac resynchronization therapy
Fig. 3
Fig. 3
Forest plot of change in LVEF between groups. A random-effects model and inverse variance (IV) method were used to pool data. Abbreviations: SD, standard deviation; other abbreviations as in Fig. 2
Fig. 4
Fig. 4
Forest plot of change in LVESV between groups. A random-effects model and inverse variance (IV) method were used to pool data. Abbreviations as in Fig. 3
Fig. 5
Fig. 5
a Forest plot of a HF hospitalization between groups, b mortality rate between groups. A random-effects model and Mantel–Haenszel method were used to pool data. Abbreviations as in Fig. 2
Fig. 6
Fig. 6
Forest plot of concordance of LV between groups. A random-effects model and Mantel–Haenszel method were used to pool data. Abbreviations as in Fig. 2
Fig. 7
Fig. 7
Funnel plot of CRT response between groups
See this image and copyright information in PMC

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