BACKGROUND: Cardiac resynchronization therapy (CRT) has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony. While CRT improves symptoms, reduces hospitalizations, and enhances survival, the role of implantable cardioverter-defibrillators (ICDs) alongside CRT in patients with non-ischemic cardiomyopathy (NICM) remains controversial. To evaluate and compare the outcomes of CRT with ICD (CRT-D) versus CRT with pacemaker-only (CRT-P) in individuals diagnosed with NICM, with a specific focus on the elderly. METHODS: A comprehensive search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted in January 2024. Studies comparing CRT-D and CRT-P in patients with NICM were included, with subgroup analyses focusing on patients aged 75 years and older. RESULTS: Twelve studies, including two randomized clinical trials, with a total of 62,145 patients and 16,754 pooled death events (9,171 in CRT-D and 7,583 in CRT-P), were analyzed. CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P (pooled OR = 0.72; 95% CI: 0.61-0.85; P < 0.01), with significant heterogeneity (I ² = 83%). RCT subgroup analysis, was not statistically significant (pooled OR = 0.82; 95% CI: 0.64-1.06; P = 0.41; I ² = 0%). In patients older than 75 years, no significant difference in mortality risk was observed (pooled OR 0.96; 95% CI: 0.81-1.15; I ²=39%). CONCLUSION Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly reduces all-cause mortality. However, this benefit does not extend to cardiovascular mortality, likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure. The survival advantage of CRT-D is most pronounced in younger patients, with those over 75 years of age deriving less benefit. This highlights the importance of careful patient selection, considering age and comorbidities, when deciding on ICD implantation in NICM patients.

Background: Left ventricular (LV) thrombus has a higher incidence among patients with anterior ST-elevation myocardial infarction (STEMI) when compared to other types of acute myocardial infarction and is associated with worse prognosis. The management of LV thrombus diagnosis remains challenging. Contrast echocardiography (transthoracic echocardiography, TTE) has shown potential in improving the accuracy for its diagnosis, thereby influencing treatment strategies concerning antithrombotic/anticoagulation therapy. The aim of this study was to assess the effectiveness of contrast TTE as a routine screening method for detecting LV thrombus in the acute phase of anterior STEMI. Methods: A prospective, single center, randomized controlled trial was conducted among patients with anterior STEMI. The study group underwent contrast TTE, while the control group received a conventional approach. Demographical, clinical, and diagnostic data were collected. Thrombus detection rates were compared between groups. Results: A total of 68 patients were included (32 in the study group and 36 in the control group). No substantial baseline differences were observed between groups. Thrombus detection rate was 25.0% in the study group and 13.9% in the control group, however these results did not reach statistical significance (P = 0.24). The prevalence of anterior/ apical aneurysm was higher in the study group (46.9% vs. 22.2%, P = 0.03). Conclusions Conventional TTE may be adequate for diagnosing LV thrombus in the acute phase of anterior STEMI; however, further larger-scale and multicenter studies are necessary to obtain more robust and conclusive results. Ultrasound contrast may play a significant role in the detection of anterior/apical aneurysms, which are known risk factors for the subsequent development of thrombus.