Impact of Implantable Defibrillators and Resynchronization Therapy on Outcome in Patients with Left Ventricular Dysfunction – A Meta-Analysis

Abstract

Background: The clinical benefits of cardiac resynchronization therapy (CRT) and primary prophylactic implantable cardioverter defibrillator (ICD) in patients with left ventricular systolic dysfunction (LVSD) are debated. Objective: To evaluate by a meta-analysis the effect of CRT and prophylactic ICD therapy in patients with LVSD. Methods: Eligible trials evaluating the effect of CRT vs. no-CRT, ICD vs. no-ICD and adding ICD to CRT vs. no-ICD were selected and meta-analyzed. The outcomes were: all cause mortality, cardiac mortality, hospitalization for heart failure and change in exercise tolerance and New York Heart Association class. Results: Implantation of CRT reduced all cause mortality odds ratio (OR) = 0.73 (0.60–0.89) p = 0.002 and hospitalization for heart failure OR = 0.60 (0.45, 0.80) p = 0.001, increased peak oxygen consumption by 1.77 (0.32–3.22) ml/kg/min p = 0.017 and improved New York Heart Association class by at least one class with OR = 1.52 (1.30, 1.77) p < 0.0001. Implantation of ICD reduced all-cause mortality OR = 0.75 (0.59–0.96) p = 0.025 and cardiac mortality OR = 0.63 (0.48, 0.82) p = 0.001. Adding ICD to CRT reduced all cause mortality OR = 0.69 (0.53–0.91) p = 0.008. Conclusion: Selective patients with LVSD benefit from CRT, ICD or both. Further investigations are necessary to clarify which patients benefit most from a single or combined device implantation.

High-Density Lipoprotein Transport Through Aortic Endothelial Cells Involves Scavenger Receptor BI and ATP-Binding Cassette Transporter G1

“…In this regard, it is important to mention that HDL and sphingosine-1-phosphate, which in plasma is predominantly carried by HDL, as well as SR-BI, were previously shown to elicit several signaling effects in ECs, 30,31 which favor closure of interendothelial junctions and hence restrict the paracellular pathway of transendothelial transport. [32][33][34][35] As yet, ABCG1 is only known as an important regulator of lipid efflux from macrophages to HDL. However, Terasaka et al 26 reported previously that ABCG1, unlike ABCA1, regulates the activity of endothelial nitric oxide synthase and thereby endothelium-dependent vasorelaxation in mice.…”

Comparison of CRT and CRT-D in heart failure: Systematic review of controlled trials

“…Several reviews [17,18] and one editorial comment [9] have addressed this issue, but no consensus has emerged. Abdulla et al [19] and Lam et al [20] have reported meta-analyses on this issue, but both of these focused more on the comparison of CRT vs. no CRT and ICD vs. no ICD. The advantage of Lam's study is that all the data were derived from major RCTs rather than observational studies.…”

Palliative and end-of-life care for patients with chronic heart failure and chronic lung disease

“…• cardiac resynchronisation therapy 14 • left ventricular assist devices • surgical intervention for valvular disease • ablation for atrial fibrillation • referral for transplantation.…”