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Does cardiac resynchronization therapy benefit patients with ischemic and non-ischemic cardiomyopathy similarly?

  • Author Footnotes
    1 Olshansky has acted as a consultant and speaker for Medtronic and Boston Scientific.
    Nader Makki
    Footnotes
    1 Olshansky has acted as a consultant and speaker for Medtronic and Boston Scientific.
    Affiliations
    Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, United States
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  • Author Footnotes
    1 Olshansky has acted as a consultant and speaker for Medtronic and Boston Scientific.
    Paari Dominic Swaminathan
    Footnotes
    1 Olshansky has acted as a consultant and speaker for Medtronic and Boston Scientific.
    Affiliations
    Department of Internal Medicine, Yale University, 333 Cedar St, PO Box 208042, New Haven, CT 06520, United States
    Search for articles by this author
  • Author Footnotes
    1 Olshansky has acted as a consultant and speaker for Medtronic and Boston Scientific.
    Brian Olshansky
    Correspondence
    Corresponding author at: The University of Iowa, Department of Internal Medicine, 200 Hawkins Drive, Room 4426A JCP, Iowa City, IA 52242, United States. Tel.: +1 319 331 1389.
    Footnotes
    1 Olshansky has acted as a consultant and speaker for Medtronic and Boston Scientific.
    Affiliations
    Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, United States
    Search for articles by this author
  • Author Footnotes
    1 Olshansky has acted as a consultant and speaker for Medtronic and Boston Scientific.
      Randomized clinical trials (RCTs) show that cardiac resynchronization therapy (CRT) can reduce mortality and hospitalization rates in patients with heart failure due to left ventricular systolic dysfunction and intraventricular conduction delay (IVCD) (QRS ≥ 120 ms) when used in addition to optimal medical therapy. However, approximately 30% of those who undergo CRT device implantation do not respond [
      • Abraham W.T.
      • Fisher W.G.
      • Smith A.L.
      • et al.
      Cardiac resynchronization in chronic heart failure.
      ]. It is unclear if the etiology of cardiomyopathy (ischemic versus non-ischemic) predicts response to CRT and even large RCTs have reported discrepant outcomes in CRT treated patients with ischemic and non-ischemic cardiomyopathy [
      • Becker M.
      • Zwicker C.
      • Kaminsky M.
      • et al.
      Dependency of cardiac resynchronization therapy on myocardial viability at the LV lead position.
      ]. Therefore, we performed a meta-analysis to determine if CRT has similar effects on the composite endpoint of all-cause mortality or first hospitalization for heart failure and/or cardiovascular causes in ischemic versus non-ischemic subgroups as a primary endpoint. We also evaluated the impact of CRT on all-cause mortality across these subgroups as a secondary endpoint.

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