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Review
. 2022 Feb 28:39:100979.
doi: 10.1016/j.ijcha.2022.100979. eCollection 2022 Apr.

Predictors of echocardiographic response to cardiac resynchronization therapy: A systematic review with Meta-Analysis

Rodrigo Martins  1 , Natália António  1   2 , Helena Donato  1   3 , Bárbara Oliveiros  1
Affiliations
Review

Predictors of echocardiographic response to cardiac resynchronization therapy: A systematic review with Meta-Analysis

Rodrigo Martins et al. Int J Cardiol Heart Vasc. .

Abstract

Background: At least 30% of the patients do not respond to cardiac resynchronization therapy (CRT). We performed a systematic review and meta-analysis of real-world studies trying to identify predictors of response to CRT.

Methods: PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for observational prospective studies, referring the evaluation of response to CRT, defined as a decrease in left ventricle end-systolic volume (LVESV) ≥ 15% at 6-month follow-up, via two-dimensional echocardiography.

Results: A total of 24 studies were included. The meta-analysis showed that female gender (p = 0.018), non-ischemic cardiomyopathy (NICM) (p < 0.001), left bundle branch morphology (LBBB) (p = 0.001), longer QRS (p < 0.001) and New York Heart Association (NYHA) class II (p = 0.014) appear to favor response to CRT. After ROC analysis and logistic regression procedures, female gender (kappa = 0.450; p < 0.001), NICM (kappa = 0.636; p < 0.001), LBBB (kappa = 0.935; p < 0.001), and NYHA class II (kappa = 0.647; p < 0.001) were identified as independent predictors of response to CRT, being LBBB the most reliable one (sensitivity = 97.24%; specificity = 98.86%).

Conclusions: Female gender, NICM, LBBB and NYHA class II are baseline variables with an apparent capability to independently predict response to CRT, being LBBB the most reliable one.

Keywords: Cardiac resynchronization therapy; Left bundle branch block; Left ventricular remodeling; Predictors; Response.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of search strategy.
Fig. 2
Fig. 2
Forest plot with the summary of all the meta-analyses performed.
Fig. 3
Fig. 3
Forest plots for the most relevant meta-analyses, with all the contributing studies and synthetic overall measure considering a random-effects model.
See this image and copyright information in PMC

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