title: Cardiac resynchronization therapy and QRS duration: systematic review, meta-analysis, and meta-regression.
abstract: Cardiac resynchronization therapy (CRT) has been shown to reduce the risk of death and hospitalization in patients with advanced heart failure with left ventricular dysfunction. However, controversy remains regarding who would most benefit from CRT. We performed a meta-analysis, and meta-regression in an attempt to identify factors that determine the outcome after CRT. A total of 23 trials comprising 10,103 patients were selected for this meta-analysis. Our analysis revealed that CRT significantly reduced the risk of all-cause mortality and hospitalization for heart failure compared to control treatment. The odds ratio (OR) of all-cause death had a linear relationship with mean QRS duration (P=0.009). The benefit in survival was confined to patients with a QRS duration ≥145 ms (OR, 0.86; 95% CI, 0.74-0.99), while no benefit was shown among patients with a QRS duration of 130 ms (OR, 1.00; 95% CI, 0.80-1.25) or less. Hospitalization for heart failure was shown to be significantly reduced in patients with a QRS duration ≥127 ms (OR, 0.77; 95% CI, 0.60-0.98). This meta-regression analysis implies that patients with a QRS duration ≥150 ms would most benefit from CRT, and in those with a QRS duration <130 ms CRT implantation may be potentially harmful.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Si-Hyuck
authors.identifier: 0000-0003-4755-6367
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Il-Young
authors.identifier: 0000-0002-5584-605X
authors.initials: IY
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.
authors.forename: Do-Yoon
authors.identifier: 0000-0002-6307-0562
authors.initials: DY
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.
authors.forename: Myung-Jin
authors.identifier: 0000-0001-6180-0157
authors.initials: MJ
authors.lastname: Cha
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.
authors.forename: Youngjin
authors.identifier: 0000-0002-9263-9957
authors.initials: Y
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.
authors.forename: Eue-Keun
authors.identifier: 0000-0002-0411-6372
authors.initials: EK
authors.lastname: Choi
authors.affiliation: Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seokyung
authors.identifier: 0000-0002-4684-4917
authors.initials: S
authors.lastname: Hahn
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.
authors.forename: Seil
authors.identifier: 0000-0002-3836-6038
authors.initials: S
authors.lastname: Oh
mesh_terms: D002037:Bundle-Branch Block / Q000503:physiopathology; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009200:Myocardial Contraction / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*
keywords: Cardiac Resynchronization Therapy; Heart Failure; Meta-Analysis