Evidence map›Paper›PMID 23900696›Full record

SynthesisEuropean heart journal2013

An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure.

John G Cleland, William T Abraham, Cecilia Linde, Michael R Gold, James B Young, J Claude Daubert, Lou Sherfesee, George A Wells, Anthony S L Tang

6 registry-linked trialsOpen access · hybridAbstract readComparative StudyMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 170 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
170citing papers in PubMed, 11 pooled it
26.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00170300 nacompletednot on this map

Outcome Trial (Long Term)to Evaluate the Effects of Cardiac Resynchronization Therapy on the Mortality and Morbidity of Patients With Heart Failure

TypeinterventionalSponsorMedtronic Cardiac Rhythm and Heart FailureRan2001 to 2005Enrolled813ConditionsHeart FailureArmsImplantable Cardiac Resynchronisation (pacing) device
NCT00251251 nacompletednot on this map

Resynchronization/Defibrillation for Ambulatory Heart Failure Trial

TypeinterventionalSponsorOttawa Heart Institute Research CorporationRan2003 to 2011Enrolled1,798ConditionsHeart Failure, CongestiveArmsOptimal Medical Therapy plus ICD, Optimal Medical Therapy plus CRT/ICD
NCT00271154 nacompletednot on this map

REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction (REVERSE)

TypeinterventionalSponsorMedtronic Cardiac Rhythm and Heart FailureRan2004 to 2011Enrolled684ConditionsHeart FailureArmsCardiac Resynchronization Therapy (CRT) Device or Implantable Cardioverter Defibrillator (ICD) with CRT
NCT03356652 naunknown statusnot on this mapstarted 2018, after this paper: background citation

Electrical Activation Mapping Guided Tailor Made Approach for Cardiac Resynchronization Therapy

TypeinterventionalSponsorChinese University of Hong KongRan2018 to 2024Enrolled93ConditionsHeart FailureArmsNoninvasive electrical dyssynchrony study
NCT04221763 nacompletednot on this mapstarted 2019, after this paper: background citation

Evaluation of Mechanisms and Innovations in Cardiac Resynchronization Therapy

TypeinterventionalSponsorImperial College LondonRan2019 to 2022Enrolled47ConditionsHeart Failure, Left Ventricular Systolic Dysfunction, Left Bundle-Branch Block, Right Bundle-Branch BlockArmsHis-bundle pacing.
NCT05491655 narecruitingnot on this mapstarted 2023, after this paper: background citation

High Intensity His Bundle Pacing in Heart Failure Patients With Narrow QRS Outcome Study

TypeinterventionalSponsorMiulli General HospitalRan2023 to 2026Enrolled34ConditionsCardiac Conduction System, His Bundle Pacing, Heart Failure, CardiomyopathiesArmsHigh Intensity His Bundle pacing
3 · Its place in the literature

Who cites it

170 citing papers in PubMed, 11 syntheses or guidelines pooled it, 516 citations in OpenAlex.

  1. Conduction System Pacing Versus Biventricular Cardiac Resynchronization in HFmrEF: A Systematic Review and Meta-Analysis.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026
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110 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 9 institutions in 5 countries.

John G ClelandNational Heart and Lung Institute, Imperial College London (Royal Brompton & Harefield Hospitals) and Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston-upon-Hull, UK.
William T Abraham
Cecilia Linde
Michael R Gold
James B Young
J Claude Daubert
Lou Sherfesee
George A Wells
Anthony S L Tang
Castle Hill Hospital · GBCentre Hospitalier Universitaire de Rennes · FRCleveland Clinic Lerner College of Medicine · USKarolinska University Hospital · SEMedical University of South Carolina · USMedtronic (United States) · USThe Ohio State University · USUniversity of British Columbia · CAUniversity of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsCardiac resynchronization therapy (CRT) with or without a defibrillator reduces morbidity and mortality in selected patients with heart failure (HF) but response can be variable. We sought to identify pre-implantation variables that predict the response to CRT in a meta-analysis using individual patient-data. METHODS AND

resultsAn individual patient meta-analysis of five randomized trials, funded by Medtronic, comparing CRT either with no active device or with a defibrillator was conducted, including the following baseline variables: age, sex, New York Heart Association class, aetiology, QRS morphology, QRS duration, left ventricular ejection fraction (LVEF), and systolic blood pressure. Outcomes were all-cause mortality and first hospitalization for HF or death. Of 3782 patients in sinus rhythm, median (inter-quartile range) age was 66 (58-73) years, QRS duration was 160 (146-176) ms, LVEF was 24 (20-28)%, and 78% had left bundle branch block. A multivariable model suggested that only QRS duration predicted the magnitude of the effect of CRT on outcomes. Further analysis produced estimated hazard ratios for the effect of CRT on all-cause mortality and on the composite of first hospitalization for HF or death that suggested increasing benefit with increasing QRS duration, the 95% confidence bounds excluding 1.0 at ∼140 ms for each endpoint, suggesting a high probability of substantial benefit from CRT when QRS duration exceeds this value.

conclusionQRS duration is a powerful predictor of the effects of CRT on morbidity and mortality in patients with symptomatic HF and left ventricular systolic dysfunction who are in sinus rhythm. QRS morphology did not provide additional information about clinical response. CLINICALTRIALSGOV NUMBERS: NCT00170300, NCT00271154, NCT00251251.

Indexed as

AgedBundle-Branch BlockCardiac Resynchronization TherapyCause of DeathDefibrillators, ImplantableFemaleHeart FailureHospitalizationHumansMaleMiddle AgedRandomized Controlled Trials as TopicStroke VolumeTreatment OutcomeVentricular Dysfunction, LeftCardiac resynchronization therapyHeart failureMorbidityMortality

Identifiers

PMID23900696
PMCPMC3855551
OpenAlexW2113572732

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.