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Cardiac resynchronization therapy and outcomes in patients with left ventricular assist devices: a systematic review and meta-analysis

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Abstract

The impact of cardiac resynchronization therapy (CRT) on clinical outcome in patients with a continuous-flow left ventricular assist device (LVAD) is currently not well understood. We conducted a systematic literature review and meta-analysis with an intention to summarize all published clinical evidence. We searched MEDLINE and EMBASE databases through March 2018 for studies that compared the outcomes in patients with LVAD and CRT. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effects model, inverse variance method. The between-study heterogeneity was assessed using the Q statistic and I2. A total of seven studies that included 1157 (575 CRT; 582 non-CRT) patients were identified. Our meta-analysis did not demonstrate a significant difference in the risk of mortality (pooled OR = 1.21, 95% CI 0.90–1.63, P = 0.21), ventricular arrhythmia incidence (pooled OR = 1.36, 95% CI 0.99–1.86, P = 0.06), hospitalization (pooled OR = 1.36, 95% CI 0.59–3.14, P = 0.48), or implantable cardioverter defibrillator therapies (pooled OR = 1.08, 95% CI 0.51–2.30, P = 0.84) among the CRT group compared with the non-CRT group. There was high heterogeneity with an I2 of 75% for ICD therapies. Among LVAD patients, CRT combined did not significantly affect mortality, re-hospitalization, ventricular arrhythmia incidence, and ICD therapies.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA

    Dinesh Chandra Voruganti & Mohsan Chaudhry

  2. Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Alexandros Briasoulis, Paulino Alvarez & Michael Giudici

  3. Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Cincinnati Hospitals, Cincinnati, OH, USA

    Vlad Cotarlan

  4. Department of Surgery, Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Jay K. Bhama

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  1. Dinesh Chandra Voruganti
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  2. Alexandros Briasoulis
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  3. Mohsan Chaudhry
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  4. Paulino Alvarez
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  5. Vlad Cotarlan
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  6. Jay K. Bhama
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  7. Michael Giudici
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Correspondence to Dinesh Chandra Voruganti.

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Voruganti, D.C., Briasoulis, A., Chaudhry, M. et al. Cardiac resynchronization therapy and outcomes in patients with left ventricular assist devices: a systematic review and meta-analysis. Heart Fail Rev 24, 229–236 (2019). https://doi.org/10.1007/s10741-018-9740-x

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  • DOI: https://doi.org/10.1007/s10741-018-9740-x

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