ABSTRACT
Abstract Background: Recent studies suggest that baseline prolonged PR interval is associated with worse outcome in cardiac resynchronization therapy (CRT). However, a systematic review and meta-analysis of the literature have not been made. Objective: To assess the association between baseline prolonged PR interval and adverse outcomes of CRT by a systematic review of the literature and a meta-analysis. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2017. The included studies were published prospective or retrospective cohort studies that compared all-cause mortality, HF hospitalization, and composite outcome of CRT with baseline prolonged PR (> 200 msec) versus normal PR interval. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the risk ratios and 95% confidence intervals. Results: Six studies from January 1991 to May 2017 were included in this meta-analysis. All-cause mortality rate is available in four studies involving 17,432 normal PR and 4,278 prolonged PR. Heart failure hospitalization is available in two studies involving 16,152 normal PR and 3,031 prolonged PR. Composite outcome is available in four studies involving 17,001 normal PR and 3,866 prolonged PR. Prolonged PR interval was associated with increased risk of all-cause mortality (pooled risk ratio = 1.34, 95 % confidence interval: 1.08-1.67, p < 0.01, I2= 57.0%), heart failure hospitalization (pooled risk ratio = 1.30, 95 % confidence interval: 1.16-1.45, p < 0.01, I2= 6.6%) and composite outcome (pooled risk ratio = 1.21, 95% confidence interval: 1.13-1.30, p < 0.01, I2= 0%). Conclusions: Our systematic review and meta-analysis support the hypothesis that baseline prolonged PR interval is a predictor of all-cause mortality, heart failure hospitalization, and composite outcome in CRT patients.
Resumo Fundamento: Estudos recentes sugerem que intervalo PR basal prolongado está associado a prognóstico ruim para a terapia de ressincronização cardíaca (TRC). No entanto, nunca foram feitas uma revisão sistemática e meta-análise da literatura. Objetivo: Avaliar a associação entre intervalo PR basal prolongado e resultados adversos da TRC por meio de uma revisão sistemática e meta-análise da literatura. Métodos: Pesquisamos de forma abrangente os bancos de dados MEDLINE e EMBASE, desde o início até março de 2017. Os estudos incluídos eram de coorte prospectivos ou retrospectivos que comparavam mortalidade por todas as causas, hospitalização por insuficiência cardíaca e desfecho composto por TRC com PR basal prolongado (> 200 ms) versus intervalo PR normal. Os dados de cada estudo foram combinados pelo modelo de efeitos aleatórios, variância genérica inversa de DerSimonian e Laird para calcular as razões de risco e os intervalos de confiança de 95% (IC95%). Resultados: Foram incluídos seis estudos de janeiro de 1991 a maio de 2017 nesta metanálise. A taxa de mortalidade por todas as causas foi mencionada em quatro estudos envolvendo 17.432 intervalos PR normais e 4.278 prolongados. Hospitalização por insuficiência cardíaca foi abordada em dois estudos envolvendo 16.152 PR normais e 3.031 prolongados. Desfecho composto esteve presente em quatro estudos com 17.001 PR normais e 3.866 prolongadas. Intervalo PR prolongado foi associado a risco aumentado de mortalidade por todas as causas (razão de risco agrupado = 1,34, IC95%: 1,08-1,67, p < 0,01, I2= 57,0%), hospitalização por insuficiência cardíaca (razão de risco agrupado = 1,30, 95 % de IC95%: 1,16-1,45, p < 0,01, I2= 6,6%) e desfecho composto (razão de risco agrupado = 1,21, IC95%: 1,13-1,30, p < 0,01, I2= 0%). Conclusões: Nossa revisão sistemática e metanálise suportam a hipótese de que o intervalo PR basal prolongado é um preditor de mortalidade por todas as causas, hospitalização por insuficiência cardíaca e desfecho composto em pacientes submetidos à TRC.
Subject(s)
Humans , Atrioventricular Block/diagnosis , Cardiac Resynchronization Therapy/methods , Heart Failure/therapy , Prognosis , Treatment Outcome , Risk Assessment , Electrocardiography , Atrioventricular Block/therapy , Heart Failure/physiopathology , Heart Failure/mortality , Hospitalization/statistics & numerical dataABSTRACT
Abstract Introduction: There is inconclusive evidence whether osteoporosis increases risk of hearing loss in current literature. Objective: We conducted this meta-analysis to determine whether there is an association between hearing loss and osteoporosis. Methods: This systematic review and meta-analysis was conducted from studies of MEDLINE, EMBASE, and LILACS. Osteoporosis was defined as having a bone mineral density with a T-score of less than −2.5 standard deviation. The outcome was hearing loss as assessed by audiometry or self-reported assessment. Random-effects model and pooled hazard ratio, risk ratio, or odds ratio of hearing loss with 95% confidence intervals were compared between normal bone mineral density and low bone mineral density or osteoporosis. Results: A total of 16 articles underwent full-length review. Overall, there was a statistically significant increased odds of hearing loss in the low bone mineral density or osteoporosis group with odds ratio of 1.20 (95% confidence intervals 1.01-1.42, p = 0.04, I 2 = 82%, Pheterogeneity = 0.01). However, the study from Helzner et al. reported significantly increase odds of hearing loss in the low bone mineral density in particular area and population included femoral neck of black men 1.37 (95% confidence intervals 1.07-1.76, p = 0.01) and total hip of black men 1.36 (95% confidence intervals 1.05-1.76, p = 0.02). Conclusion: Our study proposed the first meta-analysis that demonstrated a probable association between hearing loss and bone mineral density. Osteoporosis could be a risk factor in hearing loss and might play an important role in age-related hearing loss.
Abstract Introduction: There is inconclusive evidence whether osteoporosis increases risk of hearing loss in current literature. Objective: We conducted this meta-analysis to determine whether there is an association between hearing loss and osteoporosis. Methods: This systematic review and meta-analysis was conducted from studies of MEDLINE, EMBASE, and LILACS. Osteoporosis was defined as having a bone mineral density with a T-score of less than −2.5 standard deviation. The outcome was hearing loss as assessed by audiometry or self-reported assessment. Random-effects model and pooled hazard ratio, risk ratio, or odds ratio of hearing loss with 95% confidence intervals were compared between normal bone mineral density and low bone mineral density or osteoporosis. Results: A total of 16 articles underwent full-length review. Overall, there was a statistically significant increased odds of hearing loss in the low bone mineral density or osteoporosis group with odds ratio of 1.20 (95% confidence intervals 1.01-1.42, p = 0.04, I 2 = 82%, Pheterogeneity = 0.01). However, the study from Helzner et al. reported significantly increase odds of hearing loss in the low bone mineral density in particular area and population included femoral neck of black men 1.37 (95% confidence intervals 1.07-1.76, p = 0.01) and total hip of black men 1.36 (95% confidence intervals 1.05-1.76, p = 0.02). Conclusion: Our study proposed the first meta-analysis that demonstrated a probable association between hearing loss and bone mineral density. Osteoporosis could be a risk factor in hearing loss and might play an important role in age-related hearing loss.