Cardiac Resynchronization Therapy With or Without Defibrillation in Patients With Nonischemic Cardiomyopathy: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Cardiac resynchronization therapy (CRT) represents a major medical advance in patients with heart failure with electrical dyssynchrony to improve symptoms, reduce hospitalization, and increase survival both in the presence and absence of implantable cardioverter-defibrillator therapy. However, among CRT-eligible patients with nonischemic cardiomyopathy (NICM), the benefit of defibrillator therapy in addition to CRT remains unclear. A systematic review and meta-analysis comparing outcomes of patients with NICM and heart failure who underwent CRT with implantable cardioverter-defibrillator (CRT-D) versus CRT-pacemaker only (CRT-P) was, therefore, performed. Methods: A literature search from inception through February 2020 was conducted in PubMed and Cochrane Review Databases for all studies reporting outcomes of CRT-D versus CRT-P in CRT-eligible patients with NICM. Studies reporting nonstratified outcomes, including patients with ischemic cardiomyopathy, were excluded. The primary end point of interest was all-cause mortality. A random-effects model using hazards ratio (HR) was used to calculate a cumulative HR for all-cause mortality. The Grading of Recommendations Assessment, Development, and Evaluation approach assessed the certainty of evidence across outcomes. Results: Of a total of 1478 potential citations, the search yielded 8 citations that met inclusion and exclusion criteria. There was one randomized controlled trial which included a subgroup of 645 CRT-eligible patients with NICM (322 with CRT-D and 323 with CRT-P). Seven observational studies representing 9944 CRT-eligible patients with NICM (6865 CRT-D implantation and 3079 with CRT-P) were included in a pooled meta-analysis. The cumulative adjusted HR for all-cause mortality for CRT-D versus CRT-P was 0.92 (95% CI, 0.83–1.03); I 2 =0 though with low certainty of evidence. There may be little difference in infection and cardiac mortality between CRT-D versus CRT-P devices (HR, 0.82 [95% CI, 0.29–2.20] moderate certainty of evidence and HR, 0.68 [95% CI, 0.37–1.25], low certainty of evidence, respectively). Conclusions: In this meta-analysis, the addition of defibrillator therapy was not significantly associated with a reduction in all-cause mortality in CRT-eligible patients with NICM.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.010 | 0.001 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".