Imperial College London

ProfessorDarrelFrancis

Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology
 
 
 
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Contact

 

+44 (0)20 7594 3381d.francis Website

 
 
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Assistant

 

Miss Juliet Holmes +44 (0)20 7594 5735

 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Arnold:2019:ehjqcco/qcz006,
author = {Arnold, A and Howard, J and Chiew, K and Kerrigan, W and de, Vere F and Johns, H and Churilov, L and Ahmad, Y and Keene, D and Shun-Shin, M and Cole, G and Kanagaratnam, P and Sohaib, S and Varnava, A and Francis, D and Whinnett, Z},
doi = {ehjqcco/qcz006},
journal = {European Heart Journal - Quality of Care and Clinical Outcomes},
title = {Right ventricular pacing for hypertrophic obstructive cardiomyopathy: meta-analysis and meta-regression of clinical trials},
url = {http://dx.doi.org/10.1093/ehjqcco/qcz006},
year = {2019}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - AimsRight ventricular pacing for left ventricular outflow tract gradient reduction in hypertrophic obstructive cardiomyopathy remains controversial. We undertook a meta-analysis for echocardiographic and functional outcomes.Methods and resultsThirty-four studies comprising 1135 patients met eligibility criteria. In the four blinded randomized controlled trials (RCTs), pacing reduced gradient by 35% [95% confidence interval (CI) 23.2–46.9, P < 0.0001], but there was only a trend towards improved New York Heart Association (NYHA) class [odds ratio (OR) 1.82, CI 0.96–3.44; P = 0.066]. The unblinded observational studies reported a 54.3% (CI 44.1–64.6, P < 0.0001) reduction in gradient, which was a 18.6% greater reduction than the RCTs (P = 0.0351 for difference between study designs). Observational studies reported an effect on unblinded NYHA class at an OR of 8.39 (CI 4.39–16.04, P < 0.0001), 450% larger than the OR in RCTs (P = 0.0042 for difference between study designs). Across all studies, the gradient progressively decreased at longer follow durations, by 5.2% per month (CI 2.5–7.9, P = 0.0001).ConclusionRight ventricular pacing reduces gradient in blinded RCTs. There is a non-significant trend to reduction in NYHA class. The bias in assessment of NYHA class in observational studies appears to be more than twice as large as any genuine treatment effect.
AU - Arnold,A
AU - Howard,J
AU - Chiew,K
AU - Kerrigan,W
AU - de,Vere F
AU - Johns,H
AU - Churilov,L
AU - Ahmad,Y
AU - Keene,D
AU - Shun-Shin,M
AU - Cole,G
AU - Kanagaratnam,P
AU - Sohaib,S
AU - Varnava,A
AU - Francis,D
AU - Whinnett,Z
DO - ehjqcco/qcz006
PY - 2019///
SN - 2058-5225
TI - Right ventricular pacing for hypertrophic obstructive cardiomyopathy: meta-analysis and meta-regression of clinical trials
T2 - European Heart Journal - Quality of Care and Clinical Outcomes
UR - http://dx.doi.org/10.1093/ehjqcco/qcz006
UR - http://hdl.handle.net/10044/1/67284
ER -