Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis

Table 1

Summary of study characteristics.

First author (year); Study name	Study design, study sites, and locations	Image-guided method	Study arms (N)	Outcomes of interest	Risk of bias; A B C D E F G
Khan [10] (2012); TARGET	RCT (1 : 1); 2 sites; United Kingdom	2D Echo/STE	Image-guided: 110 enrolled; 103 completed; SOC: 110 enrolled; 104 completed	Primary: ≥ 15% reduction in LVESV at 6 months; Other: ≥1 improvement in the NYHA class, change in the NYHA class, relative change in LVESV, absolute change in LVEF, absolute change in LVEDV—all at 6 months
Saba [11] (2013); STARTER	RCT (3 : 2); 1 site; United States	2D Echo/STE	Image-guided: 110 enrolled; 73 completed; SOC: 77 enrolled; 48 completed	Primary: all-cause mortality or HF hospitalization (mean follow-up 1.8 years (±1.3 years)); Other: all-cause mortality (mean 1.8 years follow-up), HF hospitalization (mean 1.8 years follow-up), relative change in LVESV (at 6 months), and absolute change in LVEF (at 6 months)
Sommer [19] (2016); Imaging CRT	RCT (1 : 1); 1 site; Denmark	2D Echo/STE + SPECT + CT	Image-guided: 89 enrolled; 88 completed; Electrically guided: 93 enrolled; 91 completed	Primary: all-cause mortality, HF hospitalization, or improvement (NYHA class and QOL); Other: HF hospitalization or death at 1.8 years, relative change in LVESV, absolute change in LVEF, relative change in LVEDV, and ≥1 improvement in NYHA class—all at 6 months
Stephansen [18] (2019); Electro-CRT	RCT (1 : 1); 1 site; Denmark	2D Echo/STE + PET + CT	Image-guided: 62 enrolled; 59 completed; Electrically guided + CT: 60 enrolled; 54 completed	Primary: absolute change in LVEF at 6 months; Other: ≥ 1 improvement in the NYHA class, change in LVESV, change in LVEDV, clinical response (death, HF hospitalization, or improvement (NYHA class and QOL))—all at 6 months
Borgquist [17] (2020)	RCT (1 : 1); 1 site; Sweden	2D Echo/STE + CMR + CT	Image-guided: 55 randomized; 53 completed; SOC + CT/CMR if available: 52 randomized; 49 completed	Primary: ≥15% reduction in LVESV at 6 months; Other: all-cause mortality (within 2 years), all-cause mortality or HF hospitalization (within 2 years), HF hospitalization (within 2 years), ≥1 improvement in NYHA class

CMR = cardiac magnetic resonance; CT = computed tomography; Echo = echocardiogram; HF = heart failure; LV = left ventricular; LVEDV = left ventricular end-diastolic volume; LVEF = left ventricular ejection fraction; LVESV = left ventricular end-systolic volume; NYHA = New York Heart Association class; Obs = observational; PET = positron emission tomography; QOL = quality of life; SD = standard deviation; SOC = standard of care; STE = speckle tracking echocardiogram; risk of bias: A = randomization process, B = assignment to intervention, C = adhering to intervention, D = missing outcome data, E = measurement of outcome, F = selection of reported results, and G = overall (green indicates “low”, yellow indicates “some”, and red indicates “high” risk of bias).