Contractile reserve as a predictor of prognosis in non-ischaemic systolic heart failure: a systematic review and meta-analysis

• Published in: Echo research and practice 2017-12
• Main Authors: Waddingham, Peter H, Bhattacharyya, Sanjeev, Van Zalen, Jet, Lloyd, Guy
• Format: Article
• Language: English
• ISSN: 2055-0464; 2055-0464
• DOI: 10.1530/ERP-17-0054

Patients with non-ischaemic systolic heart failure (HF) and idiopathic dilated cardiomyopathy (DCM) are a heterogenous group with varied morbidity and mortality. Prognostication in this group is challenging. We performed a systematic review and meta-analysis to examine the significance of the presence of contractile reserve as assessed via stress imaging on mortality and hospitalisation. A search for studies that non-invasively assessed contractile reserve in patients with DCM or non-ischaemic HF with reduced ejection fraction; stress imaging with follow up data comparing outcomes. A range of imaging modalities and stressors were included. We examined primary end points of mortality; secondary endpoints of combined cardiovascular events including HF progression or hospitalisation. Our analysis compared endpoints in patients with contractile reserve and those without. Nine prospective cohort studies were identified describing a total of 787 patients. These studies are methodologically but not statistically heterogenous (I2 = 31%). Using a random effects model, the presence of contractile reserve was associated with significantly lower risk of mortality and cardiovascular events odds ratios of 0.20 (CI 0.11, 0.39) ( p