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Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies

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Abstract

Cardiac resynchronization therapy (CRT) may improve not only impaired left ventricular contractility but can also induce reverse remodeling of native conduction system. Measurement of intrinsic QRS complex width during follow-up is the simplest method to assess reverse electrical remodeling (RER). We aimed to provide a literature review and meta-analysis on incidence and impact of RER and its association with mechanical remodeling. A systematic review and random-effect meta-analysis of studies reporting data on RER was performed. A total of 16 studies were included in this meta-analysis with 930 patients undergoing CRT (mean age 64.0 years, 64.1% males). The weighted mean incidence of RER was 42%. Reverse mechanical remodeling assessed by echocardiography was more frequently observed in patients with RER compared to patients without RER (75.7% vs. 46.6%; odds ratio [OR] 3.7, 95% confidence interval [CI] 2.24–6.09, p < 0.01). Mechanical responders had a mean iQRS shortening of 7.7 ms, while mechanical non-responders experienced a mean widening of iQRS by 5.2 ms (p < 0.01). Clinical improvement was more frequent in patients with RER vs. patients without RER (82.9% vs. 49.0%; OR 5.26; 95% CI 2.92–9.48; p < 0.01). No significant difference in all‐cause mortality between patients with and without RER was found. Mean difference between baseline intrinsic QRS and post-implantation paced QRS was significant in patients with later RER (21.2 ms, 95% CI 9.4–32.9, p < 0.01), but not in patients without RER (6.6 ms, 95% CI -2.2–15.4, p = 0.14). Gender, initial left bundle block morphology and heart failure etiology were found not to be predictive for RER. Our meta-analysis demonstrates that shortening of iQRS duration is a common finding during follow-up of patients undergoing CRT and is associated with mechanical reverse remodeling and clinical improvement. Clinical Trial Registration: Prospero Database-CRD42021253336.

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Acknowledgements

Special thanks to Marta Cvijic MD PhD for her support in data collection.

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Authors and Affiliations

  1. Doctoral School of Basic and Translational Medicine, Semmelweis University, Budapest, Hungary

    David Pilecky & Mate Vamos

  2. Department of Internal Medicine III, Klinikum Passau, Passau, Germany

    David Pilecky & Dietmar Elsner

  3. Medical Centre - Hungarian Defense Forces, Budapest, Hungary

    Gabor Z. Duray

  4. Department of Medicine - Cardiology, Diabetology and Nephrology, Bethel-Clinic, Bielefeld, Germany

    Carsten W. Israel

  5. Department of Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany

    Julia W. Erath-Honold

  6. Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary

    Mate Vamos

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  1. David Pilecky
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Contributions

D.P. designed the study, performed data collection and statistical analysis and drafted the manuscript. M.V. participated on study conceptualization, data collection and statistical analysis, and revised the manuscript. G.Z.D, D.E., C.W.I and J.W.E. contributed to data interpretation and revised the manuscript for important intellectual content.

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Correspondence to David Pilecky.

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Conflict of interest

D.P. and D.E. have no conflict of interest. G. Z. D. reports consulting/lecture fees and/or nonfinancial support from Abbott, Biotronik, Daiichi Sankyo, Medtronic, MSD, Replant, Richter, Pfizer, and Sanofi. C. W. I. reports consulting/lecture fees and/or nonfinancial support from Abbott, Biotronik, Boston-Scientific, Medtronic, MicroPort/Sorin. J. W. E. reports receiving consultant fees, travel support and lecture fees from ZOLL Medical, travel grants from Bayer Vital, St. Jude Medical/Abbott, Novartis and lecture fees from Servier, Pfizer and Bayer and was a fellow of the Boston Scientific heart rhythm fellowship program. M.V. reports consulting fees and/or nonfinancial support from Biotronik, Medtronic, Minimal Invasive Technology Ltd. and Pfizer, outside the submitted work.

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Pilecky, D., Duray, G.Z., Elsner, D. et al. Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies. Heart Fail Rev 27, 2165–2176 (2022). https://doi.org/10.1007/s10741-022-10234-w

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