Bytyçi Ibadete, Bajraktari Gani, Henein Michael Y
Institute of Public Health and Clinical Medicine, Umeå University, Sweden.
Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo.
Arch Med Sci. 2020 Jan 10;18(4):930-938. doi: 10.5114/aoms.2019.91511. eCollection 2022.
In responders, cardiac resynchronisation therapy (CRT) results in improved left ventricular (LV) function and reduced atrial arrhythmia. The aim of this meta-analysis was to assess the potential relationship between the left atrium (LA) volume and CRT response.
We systematically searched all electronic databases up to August 2018 in order to select clinical trials and observational studies that assessed the predictive value of LA volume index (LAVI) of CRT response. Left ventricular end-systolic volume (LVESV) reduction ≥ 15 ml and/or LV ejection fraction (EF) increase ≥ 10% were the documented criteria for positive CRT response.
A total of 2191 patients recruited in 10 studies with mean follow-up duration of 10.5 months were included in this meta-analysis. The pooled analysis showed that CRT responders had lower baseline LAVI compared to non-responders, with a weighted mean difference (WMD) of -5.89% (95% CI: -9.47 to -3.22, < 0.001). At follow-up, LAVI fell in the CRT responders (WMD -4.36%, 95% CI: -3.54 to -5.17, < 0.001) compared to non-responders (WMD 1.45 %, 95% CI: -0.75 to 3.65, = 0.20). The mean change of LAVI in the CRT responders was related to the fall in LVESV, β = -1.02 (-1.46 to -0.58), < 0.001 and the increase in LVEF, β = 2.02 (1.86 to 4.58), = 0.001. A baseline LAVI < 34 ml/m predicted CRT response with summary sensitivity 0.80% (0.53-0.95), specificity 0.74% (0.53-0.89), and odds ratio > 11.
Baseline LAVI predicts CRT response, and its reduction reflects devise-related LA remodelling. These results emphasis the role of LAVI assessment as an integral part of cardiac function response to CRT.
在有反应者中，心脏再同步治疗（CRT）可改善左心室（LV）功能并减少房性心律失常。本荟萃分析的目的是评估左心房（LA）容积与CRT反应之间的潜在关系。
我们系统检索了截至2018年8月的所有电子数据库，以选择评估CRT反应的左心房容积指数（LAVI）预测价值的临床试验和观察性研究。左心室收缩末期容积（LVESV）减少≥15 ml和/或左心室射血分数（EF）增加≥10%是记录的CRT阳性反应标准。
本荟萃分析纳入了10项研究中的2191例患者，平均随访时间为10.5个月。汇总分析显示，与无反应者相比，CRT有反应者的基线LAVI较低，加权平均差（WMD）为-5.89%（95% CI：-9.47至-3.22，<0.001）。随访时，与无反应者（WMD 1.45%，95% CI：-0.75至3.65，P = 0.20）相比，CRT有反应者的LAVI下降（WMD -4.36%，95% CI：-3.54至-5.17，<0.001）。CRT有反应者中LAVI的平均变化与LVESV的下降相关，β = -1.02（-1.46至-0.58），<0.001，与LVEF的增加相关，β = 2.02（1.86至4.58），P = 0.001。基线LAVI < 34 ml/m²预测CRT反应的汇总敏感度为0.80%（0.53 - 0.95），特异度为0.74%（0.53 - 0.89），比值比> 11。
基线LAVI可预测CRT反应，其降低反映了与装置相关的LA重塑。这些结果强调了LAVI评估作为心脏对CRT功能反应不可或缺部分的作用。
