The role of contractile reserve by stress test echocardiography for predicting cardiac resynchronization therapy responder: systematic review and meta-analysis

Authors

  • Achmad Lefi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
  • Ivana Purnama Dewi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia; Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
  • Kristin Purnama Dewi Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
  • Eka Prasetya Budi Mulia Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
  • Agus Subagjo Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
  • Budi Dharmadjati Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.5725

Keywords:

contractile reserve, cardiac resynchronization therapy, CRT responder, stress test echocardiography, dobutamine stress echocardiography, exercise test

Abstract

Introduction: Up to one-third of patients who received resynchronization devices do not experience full benefit of cardiac resynchronization therapy (CRT). Echocardiography plays an important role in heart failure patients treated with CRT. Contractile reserved is a strong prognostic factor to predict positive response to CRT (CRT responder).

Objective: We perform a systematic review and meta-analysis of published data to assess the relationship between contractile reserve (CR) and response to CRT.

Methods: We conduct a systematic search from major medical databases on all clinical trials published up to June 2020, written in English, full-text availability, and human subject. We used Newcastle-Ottawa Scale to measure the quality of evidence. We employed the Mantel–Haenszel random-effects meta-analysis of using RevMan 5.4.

Results: We identified 17 studies involving 1399 patients. The type of stress was either dobutamine (n=15) or exercise (n=2). The presence of CR was associated with a higher chance of CRT responder (OR 7.68, 95%CI 4.27–13.82, p<0.001) using a random-effects model. The ORs slightly differed when studies were analyzed separately based on the stress test type and definition of CR. Contractile reserve, assessed with dobutamine stress echocardiography (DSE), defined as an increase in LVEF (OR 5.10, 95% CI 2.29–11.32, P <0.00001) was numerically lower than defined as increased LV contractility (OR 6.86, 95% CI 3.36–12.88, P <0.00001). The presence of CR assessed with exercise stress test are associated with higher chance of CRT responder (OR 49.11, 95% CI 15.04–160.36, P <0.00001). From our meta-analysis, we found non-ischemic has better respond to CRT compare to patient with ischemic etiology (OR 0.41; 95% CI 0.31-0.55, P <0.01).

Conclusion: The presence of CR during stress test echocardiography with either dobutamine or exercise stress test is associated with a higher chance of CRT responder.

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References

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Published

2021-03-02

How to Cite

1.
Lefi A, Dewi IP, Dewi KP, Mulia EPB, Subagjo A, Dharmadjati B. The role of contractile reserve by stress test echocardiography for predicting cardiac resynchronization therapy responder: systematic review and meta-analysis. Open Access Maced J Med Sci [Internet]. 2021 Mar. 2 [cited 2021 May 9];9(F):67-75. Available from: https://oamjms.eu/index.php/mjms/article/view/5725

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Meta-analytic Review Article

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