Predictors of echocardiographic response to cardiac resynchronization therapy: A systematic review with Meta-Analysis

Abstract

Background: At least 30% of the patients do not respond to cardiac resynchronization therapy (CRT). We performed a systematic review and meta-analysis of real-world studies trying to identify predictors of response to CRT. Methods: PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for observational prospective studies, referring the evaluation of response to CRT, defined as a decrease in left ventricle end-systolic volume (LVESV) ≥ 15% at 6-month follow-up, via two-dimensional echocardiography. Results: A total of 24 studies were included. The meta-analysis showed that female gender (p = 0.018), nonischemic cardiomyopathy (NICM) (p < 0.001), left bundle branch morphology (LBBB) (p = 0.001), longer QRS (p < 0.001) and New York Heart Association (NYHA) class II (p = 0.014) appear to favor response to CRT. After ROC analysis and logistic regression procedures, female gender (kappa = 0.450; p < 0.001), NICM (kappa = 0.636; p < 0.001), LBBB (kappa = 0.935; p < 0.001), and NYHA class II (kappa = 0.647; p < 0.001) were identified as independent predictors of response to CRT, being LBBB the most reliable one (sensitivity = 97.24%; specificity = 98.86%). Conclusions: Female gender, NICM, LBBB and NYHA class II are baseline variables with an apparent capability to independently predict response to CRT, being LBBB the most reliable one.