| Objective:Heart failure is an end-stage performance of various heat diseases,patient’s rehospitalization and death rate are high,which is one the most important angiocardiopathy diseases,our case rate of heart failure is 0.9%to 1.4%,it estimated that total number of heart failure is four million.Among of it,coronary disease is the main cause of heart failure.Because coronary disease leads to long-term ischemia myocardial,myocardial atrophy or nutrition hinder,the number of cardiomyocytes is decreasing,cardiac dysfunction,thus causing myocardial diffuse fibrosis and formulate syndrome like dilated cardiomyopathy which is called as ischemic cardiomyopathy ICM.Attack of coronary disease is high,the heart failure populace accounts for 1%to 2%of total group generally,the proportion of aged over 70 years old accounts for 10%.heart failure treatment has developed from primary symptomatic treatment of "strengthening heart,diuretic,dilating blood vessel" to apply endocrine inhibitor,strengthen management of heart failure outside hospital for changing biological nature of failure heart,and apply non-drug instrumentation therapy on the basis of the most optimum medicine treatment,the function of improving heart failure patients prognosis has been admitted normally.Cardiac resynchronization therapy has been applied in clinical for more than 30 years since 1980s,CRT can eliminate asynchronism of left and right ventricles to improve heart function and reverse ventricular remodeling effectively through realizing atrioventricular synchronous motion for moderate to severe heart failure patients of obvious left ventricular asynchrony,which can decrease case rate of heart failure and death rate and opened a new path for treating CHF in clinical.However,with CRT’s application and research observation,there were about 30%chronic heart failure patients’ CRT effect was not favorable,which means no response.Therefore,it needs to find the cause of no response,and improve CRT’s response rate through improving CRT technology and clearing CRT indication for utilizing CRT treatment means effectively.Following research was found that corresponding improvement to factors can make response rate of this kind of patients increased,such as CRT response and Left ventricular electrode position,QRS wave width,heart failure with atrial fibrillation(atrial fibrillation),serum creatinine level and so forth.however,the factor of ischemic cardiomyopathy affecting response is more complex,including old age,bad heart function,ventricular and atrial arrhythmias,MS’ effect to left ventricular electrode position and so forth,there is no unified conclusion to the reports of various researches on whether cardiac resynchronization therapy can improve ICM patients prognosis.Hence it makes meta analysis to relevant ICM heart failure patients who treated with CRT treatment for further defining whether heart failure patients of ischemic cardiomyopathy can get benefits from resynchronization therapy,whether it can improve prognosis(death rate),in order to help to determine CRT’s indication and guide heart failure patients to make resynchronization therapy effectively.Methods:Consult clinical research literature about cardiac resynchronization in the treatment of heart failure with ischemic cardiomyopathy which released before December 2017 from PubMed,EMBASE,Cochrane Library,the limited literature type is clinical randomized controlled trial,define disease’s definitive:ischemic cardiomyopathy,coronary heart disease;define definitive of intervene type:cardiac resynchronization therapy;effect index is HR and its 95%CI.Applying State 12.0 to arrange and analyze data,heterogeneity test of various clinical experiments adopted 12 test,make evaluation to heterogenicity of same research,if there happens heterogenicity,it will adopt random effect model to interpret research result cautiously.Adopting sensitive analysis to test stability of meta analysis result.Using Egger methos to test potential publication bias.Results:primary retrieval got 666 relevant papers,get rid of unconfirmed experiment design type,unconfirmed research group,unconfirmed intervene measures and contrast setting,lacking death rate data and summary,the analysis was brought into seven papers,they are all muti-central randomized controlled trials,RCTs and 9419 testers,among of it,ischemic cardiomyopathy patients are 4892,non-ischemic cardiomyopathy patients are 4527.accepting CRT can decrease(HR0.72,95%CI 0.62-0,82),all-cause mortality of ischemic cardiomyopathy and heart failure who treated with optimized drug treatment,it is suggested that the long-term prognosis is better.12 tests 77.6%and there is heterogenicity in various researches of prompt inclusion,after removed sensitive analysis by sensitive analysis,it is suggest that CRT treatment can reduce all-death mortality(HR0.64,95%CI 0.49-0.79)of ischemic cardiomyopathy patients.When consult the papers,there are partial researches found that response rate of ischemic cardiomyopathy is relate to myocardial scar location,MS of left ventricular posterolateral wall can improve response rate.This kind of researches are small sample data,hence they haven’t been brought into meta analysis,but they have guiding meaning to clinical.Conclusions:1.after treated with optimized drug treatment,cardiac resynchronization therapy can decrease death rate of ischemic cardiomyopathy and heart failure patients obviously,hence to improve long-term prognosis of this kind of patients and improve response rate.2.while implanting CRT indication by following the guidelines for the treatment of heart failure can give CRT-D intervene treatment to ischemic cardiomyopathy as quick as possible for embodying function of decreasing heart failure patients mortality of CRT-D.3.the papers meta analysis brought in is international multi-central random control test with favorable data reliability,this result needs a cautious explanation and replenish and improve by more clinical experiments. |
