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

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.

The role of guidance in delivering cardiac resynchronization therapy: A systematic review and network meta-analysis

“…A recently published meta-analysis by Hu et al, was limited to evaluating only image-guidance and included both randomised and non-randomised studies. This was limited by heterogenous study designs and excluded non-image-based guidance techniques 7 . A network meta-analysis (NMA) was deemed appropriate to allow comparative assessment of different guidance modalities and potentially direct clinicians to which guidance modalities derived most benefit for patients.…”

“… 4 The targeting of the optimal LV lead position through a variety of guidance techniques has been investigated; however, with the increasing use of image-fusion technology 5 and number of randomized trials being undertaken with more advanced imaging techniques, 6 the need for an updated evaluation of the data is needed. A recently published meta-analysis by Hu and colleagues 7 was limited to evaluating only image guidance and included both randomized and nonrandomized studies. This was limited by heterogenous study designs and excluded non-image-based guidance techniques.…”

“…This was limited by heterogenous study designs and excluded non-image-based guidance techniques. 7 A network meta-analysis (NMA) was deemed appropriate to allow comparative assessment of different guidance modalities and potentially direct clinicians to which guidance modalities derived most benefit for patients.…”

Clinical outcomes of automatic algorithms in cardiac resynchronization therapy: Systematic review and meta-analysis

“…Previous meta-analyses and RCTs showed no clinical improvement with imaging-guided optimization compared with usual care, including fixed intervals or hemodynamic optimization. 26 , 27 , 28 , 29 , 30 Ultimately, the response to CRT may be dictated in large part by patient selection and multipoint lead positioning, leaving little to be gained in AV and VV interval titration compared to fixed settings. 31 , 32 , 33 …”

The Chinese Experience of Imaging in Cardiac Intervention

“…Placement of left ventricular (LV) pacing leads at sites of latest activation in viable myocardium provides better cardiac resynchronization therapy (CRT) response. Hu et al 106 investigated the incremental efficacy of image-guided CRT over standard CRT in 1075 patients from 8 studies, of which 544 patients underwent image-guided CRT implantation and 531 underwent routine implantation without imaging guidance. Comparing the routine group, the improvement in LV ejection fraction is significantly higher in the image-guided group (weighted mean difference: 3.25, 95% CI: 1.80-4.70, P < 0.01) with no significant difference in hospitalization (RR: 0.89, 95% CI: 0.16-5.08, P = 0.90) or mortality (RR: 0.69, 95% CI: 0.37-1.29, P = 0.24).…”