An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure.
An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure.
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DOI：
10.1093/eurheartj/eht290
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发表时间：
2013-12
影响因子：
39.3
通讯作者：
Tang AS
中科院分区：
文献类型：
--
作者：
Cleland JG;Abraham WT;Linde C;Gold MR;Young JB;Claude Daubert J;Sherfesee L;Wells GA;Tang AS
使用或不使用除颤器的心脏再同步治疗(CRT)可以降低心力衰竭(HF)患者的发病率和死亡率，但反应可能会有所不同。我们试图在荟萃分析中找出植入前的变量来预测CRT对CRT的反应，该分析使用了个体患者数据。由美敦力资助的5个随机试验的个体患者荟萃分析，比较了不使用有源设备或使用除颤器的CRT，包括以下基线变量：年龄、性别、纽约心脏协会分级、病因学、QRS形态、QRS持续时间、左心室射血分数(LVEF)和收缩压。结果是全因死亡率和首次因心力衰竭或死亡住院。3782例窦性心律患者，中位年龄66岁(58~73岁)，QRS间期160(146~176)ms，LVEF 24%(20~28%)，78%有左束支传导阻滞。一个多变量模型表明，只有QRS持续时间可以预测CRT对预后的影响程度。进一步的分析得出了CRT对全因死亡率和首次住院治疗心力衰竭或死亡的组合的估计风险比，这表明随着QRS持续时间的增加，益处增加，对于每个终点，当QRS持续时间超过此值时，∼为140ms时，95%的可信区间不包括1.0%，表明CRT很有可能从CRT中获得实质性好处。QRS间期是预测CRT对窦性心律有症状性心衰和左心室收缩功能不全患者发病率和死亡率影响的有力指标。QRS形态没有提供有关临床反应的额外信息。NCT00170300、NCT00271154、NCT00251251。
Cardiac resynchronization therapy (CRT) with or without a defibrillator reduces morbidity and mortality in selected patients with heart failure (HF) but response can be variable. We sought to identify pre-implantation variables that predict the response to CRT in a meta-analysis using individual patient-data. An individual patient meta-analysis of five randomized trials, funded by Medtronic, comparing CRT either with no active device or with a defibrillator was conducted, including the following baseline variables: age, sex, New York Heart Association class, aetiology, QRS morphology, QRS duration, left ventricular ejection fraction (LVEF), and systolic blood pressure. Outcomes were all-cause mortality and first hospitalization for HF or death. Of 3782 patients in sinus rhythm, median (inter-quartile range) age was 66 (58–73) years, QRS duration was 160 (146–176) ms, LVEF was 24 (20–28)%, and 78% had left bundle branch block. A multivariable model suggested that only QRS duration predicted the magnitude of the effect of CRT on outcomes. Further analysis produced estimated hazard ratios for the effect of CRT on all-cause mortality and on the composite of first hospitalization for HF or death that suggested increasing benefit with increasing QRS duration, the 95% confidence bounds excluding 1.0 at ∼140 ms for each endpoint, suggesting a high probability of substantial benefit from CRT when QRS duration exceeds this value. QRS duration is a powerful predictor of the effects of CRT on morbidity and mortality in patients with symptomatic HF and left ventricular systolic dysfunction who are in sinus rhythm. QRS morphology did not provide additional information about clinical response. NCT00170300, NCT00271154, NCT00251251.
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影响因子：
18.2
作者：
Khan, Nasrin K.;Goode, Kevin M.;Follath, Ferenc
通讯作者：
Follath, Ferenc
影响因子：
37.8
作者：
Fornwalt BK;Sprague WW;BeDell P;Suever JD;Gerritse B;Merlino JD;Fyfe DA;León AR;Oshinski JN
通讯作者：
Oshinski JN
影响因子：
158.5
作者：
Cleland, JGF;Daubert, J;Khan, NK
通讯作者：
Khan, NK
影响因子：
24
作者：
Barsheshet, Alon;Wang, Paul J.;Goldenberg, Ilan
通讯作者：
Goldenberg, Ilan
影响因子：
158.5
作者：
Abraham, WT;Fisher, WG;McAtee, P
通讯作者：
McAtee, P