目的:在心脏再同步治疗(CRT)的无应答者中,设备编程次优是常见的。然而,设备优化的作用和最合适的技术仍然是未知的。我们研究的目的是在网络荟萃分析中分析不同CRT优化技术的效果。
方法:对MEDLINE进行了系统搜索,Embase和CENTRAL用于比较结果与使用超声心动图的经验装置设置或优化的研究,静态算法或动态算法。还分析了调查非应答者中优化效果的研究。
结果:共有17项研究纳入了4346例患者的定量分析。在检查的治疗和结果中,仅在动态算法和超声心动图之间发现了显着差异,前者导致更高的超声心动图反应率[优势比(OR):2.02,95%置信区间(CI)1.21-3.35],较低的心力衰竭住院率(OR:0.75,95%CI0.57-0.99)和6分钟步行试验的较大改善[平均差(MD):45.52m,95%可信区间(CrI)3.91-82.44m]。我们发现经验设置之间没有显着差异,静态算法和动态算法。对228名患者的7项研究报告了在非应答者优化后的应答率。总之,34.3%-66.7%的初始无反应者在优化后表现出改善,取决于反应标准。
结论:在植入CRT时,动态算法可以作为一种资源友好的替代超声心动图优化,中期结果相似或更好。然而,它们相对于经验性器械设置的优越性需要在进一步的试验中进行研究.对于非响应者,应考虑CRT优化,作为大多数患者的经验改善。
OBJECTIVE: Suboptimal device programming is frequent in non-responders to cardiac resynchronization therapy (CRT). However, the role of device optimization and the most appropriate technique are still unknown. The aim of our study was to analyse the effect of different CRT optimization techniques within a network meta-analysis.
METHODS: A systematic search was conducted on MEDLINE, Embase and CENTRAL for studies comparing outcomes with empirical device settings or optimization using echocardiography, static algorithms or dynamic algorithms. Studies investigating the effect of optimization in non-responders were also analysed.
RESULTS: A total of 17 studies with 4346 patients were included in the quantitative analysis. Of the treatments and outcomes examined, a significant difference was found only between dynamic algorithms and echocardiography, with the former leading to a higher echocardiographic response rate [odds ratio (OR): 2.02, 95% confidence interval (CI) 1.21-3.35], lower heart failure hospitalization rate (OR: 0.75, 95% CI 0.57-0.99) and greater improvement in 6-minute walk test [mean difference (MD): 45.52 m, 95% credible interval (CrI) 3.91-82.44 m]. We found no significant difference between empirical settings, static algorithms and dynamic algorithms. Seven studies with 228 patients reported response rates after optimization in non-responders. Altogether, 34.3%-66.7% of initial non-responders showed improvement after optimization, depending on response criteria.
CONCLUSIONS: At the time of CRT implantation, dynamic algorithms may serve as a resource-friendly alternative to echocardiographic optimization, with similar or better mid-term outcomes. However, their superiority over empirical device settings needs to be investigated in further trials. For non-responders, CRT optimization should be considered, as the majority of patients experience improvement.