title: Image-guided left ventricular lead placement in cardiac resynchronization therapy for patients with heart failure: a meta-analysis.
abstract: BACKGROUND
  Heart failure (HF) is a debilitating condition that affects millions of people worldwide. One means of treating HF is cardiac resynchronization therapy (CRT). Recently, several studies have examined the use of echocardiography (ECHO) in the optimization of left ventricular (LV) lead placement to increase the response to CRT. The objective of this study was to synthesize the available data on the comparative efficacy of image-guided and standard CRT.
  
  
  METHODS
  We searched the PubMed, Cochrane, Embase, and ISI Web of Knowledge databases through April 2014 with the following combinations of search terms: left ventricular lead placement, cardiac resynchronization therapy, image-guided, and echocardiography-guided. Studies meeting all of the inclusion criteria and none of the exclusion criteria were eligible for inclusion. The primary outcome measures were CRT response rate, change in LV ejection fraction (LVEF), and change in LV end systolic volume (LVESV). Secondary outcomes included the rates of all-cause mortality and HF-related hospitalization.
  
  
  RESULTS
  Our search identified 103 articles, 3 of which were included in the analysis. In total, 270 patients were randomized to the image-guided CRT and 241, to the standard CRT. The pooled estimates showed a significant benefit for image-guided CRT (CRT response: OR, 2.098, 95 % CI, 1.432-3.072; LVEF: difference in means, 3.457, 95 % CI, 1.910-5.005; LVESV: difference in means, -20.36, 95 % CI, -27.819 - -12.902).
  
  
  CONCLUSIONS
  Image-guided CRT produced significantly better clinical outcomes than the standard CRT. Additional trials are warranted to validate the use of imaging in the prospective optimization of CRT.
authors.affiliation: Department of Cardiology, Ren Ji hospital, School of Medicine, Shanghai Jiao Tong University, 200001, Shanghai, China. jessijin@msn.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Department of Cardiology, Ren Ji hospital, School of Medicine, Shanghai Jiao Tong University, 200001, Shanghai, China. junjunjun0527@hotmail.com.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Ren Ji hospital, School of Medicine, Shanghai Jiao Tong University, 200001, Shanghai, China. junjunjun0527@hotmail.com.
authors.forename: Jia-Liang
authors.initials: JL
authors.lastname: Mao
authors.affiliation: Department of Cardiology, Ren Ji hospital, School of Medicine, Shanghai Jiao Tong University, 200001, Shanghai, China. junjunjun0527@hotmail.com.
authors.forename: Ben
authors.initials: B
authors.lastname: He
mesh_terms: D001810:Blood Volume; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002423:Cause of Death; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006760:Hospitalization; D006801:Humans; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography