Cardiac resynchronization therapy in chronic Chagas cardiomyopathy: A systematic review and single-arm meta-analysis
Iuri Ferreira Felix1, Vanessa Karlinski Vizentin2, Mangesh Kritya3
1Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Insights
Cardiac resynchronization therapy (CRT) improves heart function in chronic Chagas cardiomyopathy (CCC) patients. However, high mortality rates persist, indicating a need for further investigation into CRT
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Cardiac resynchronization therapy (CRT) is established for heart failure.
- Patients with chronic Chagas cardiomyopathy (CCC) were underrepresented in pivotal CRT trials.
Purpose of the Study:
- To quantitatively assess the outcomes of CRT in patients with CCC.
- To provide a comprehensive analysis of CRT effectiveness in this specific population.
Main Methods:
- Systematic review and meta-analysis of studies on CRT in CCC patients.
- Searched PubMed, Embase, Cochrane, and LILACS without language or date restrictions.
- Utilized an inverse-variance random-effects model for meta-analysis of proportions.
Main Results:
- Included 4 studies with 250 CCC patients undergoing CRT.
- Mean LVEF improved from 27% to 36.3% post-CRT.
- NYHA class III/IV reduced from 87% to 21%, but all-cause mortality was 38%.
Conclusions:
- CRT shows benefits in improving LVEF and symptoms for CCC patients.
- High overall mortality in CCC patients post-CRT warrants further research.
- Further studies are needed to fully understand CRT's long-term impact on CCC outcomes.
Background:
Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with heart failure. However, patients with chronic Chagas cardiomyopathy (CCC) were underrepresented in pivotal CRT trials.
Objective:
This systematic review and meta-analysis aim to quantitatively describe the outcomes of CRT in patients with CCC.
Methods:
We systematically searched PubMed, Embase, Cochrane, and LILACS registries for studies evaluating the response to CRT in patients with CCC. We applied no language or date restrictions. We applied an inverse-variance random-effects model for a meta-analysis of proportions.
Results:
We included 4 observational cohort studies comprising 250 patients with CCC undergoing CRT. At CRT implantation, the mean age was 59 ± 12 years, 87% of patients (217) were New York Heart Association class III/IV, and the average left ventricular ejection fraction (LVEF) was 27% ± 7%. During a mean follow-up of 30 ± 25 months, the all-cause death rate was 38% (95% confidence interval [CI], 21-56), cardiac death rate was 29% (95% CI, 13-47), and the noncardiac death rate was 4% (95% CI, 1-9). After CRT, the proportion of patients rated New York Heart Association class III/IV was improved to 21% (95% CI, 5-44), with a pooled post-CRT LVEF of 36.3% (95% CI, 27.0-48.0).
Conclusion:
In patients with CCC, CRT was associated with improvements in LVEF and symptomatic and functional burden (class III/IV), but overall mortality remained high. Although CRT seems to be beneficial in this population, further research is warranted to better characterize its impact on long-term clinical outcomes.
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