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Heart Failure Reviews Sep 2021Heart failure (HF) is a major epidemic with rising morbidity and mortality rates that encumber global healthcare systems. While some studies have demonstrated the value... (Meta-Analysis)
Meta-Analysis Review
Heart failure (HF) is a major epidemic with rising morbidity and mortality rates that encumber global healthcare systems. While some studies have demonstrated the value of CRP in predicting (i) the development of HFpEF and (ii) long-term clinical outcomes in HFpEF patients, others have shown no such correlation. As a result, we conducted the following systematic review and meta-analysis to assess both the diagnostic and prognostic role of CRP in HFpEF. PubMed and Embase were searched for studies that assess the relationship between CRP and HFpEF using the following search terms: (((C-reactive protein) AND ((preserved ejection fraction) OR (diastolic heart failure))). The search period was from the start of database to August 6, 2019, with no language restrictions. A total of 312 and 233 studies were obtained from PubMed and Embase respectively, from which 19 studies were included. Our meta-analysis demonstrated the value of a high CRP in predicting the development of not only new onset HFpEF (HR: 1.08; 95% CI: 1.00-1.16; P = 0.04; I = 22%), but also an increased risk of cardiovascular mortality when used as a categorical (HR: 2.52; 95% CI: 1.61-3.96; P < 0.0001; I = 19%) or a continuous variable (HR: 1.24; 95% CI: 1.04-1.47; P = 0.01; I = 28%), as well as all-cause mortality when used as a categorical (HR: 1.78; 95% CI: 1.53-2.06; P < 0.00001; I = 0%) or a continuous variable: (HR: 1.06; 95% CI: 1.02-1.06; P = 0.003; I = 61%) in HFpEF patients. CRP can be used as a biomarker to predict the development of HFpEF and long-term clinical outcomes in HFpEF patients, in turn justifying its use as a simple, accessible parameter to guide clinical management in this patient population. However, more prospective studies are still required to not only explore the utility and dynamicity of CRP in HFpEF but also to determine whether risk stratification algorithms incorporating CRP actually provide a material benefit in improving patient prognosis.
Topics: C-Reactive Protein; Heart Failure; Humans; Prognosis; Prospective Studies; Stroke Volume
PubMed: 32030562
DOI: 10.1007/s10741-020-09927-x -
QJM : Monthly Journal of the... Feb 2023Variable clinical criteria taken by medical professionals across the world for myocarditis following coronavirus disease 2019 (COVID-19) vaccination along with wide...
Variable clinical criteria taken by medical professionals across the world for myocarditis following coronavirus disease 2019 (COVID-19) vaccination along with wide variation in treatment necessitates understanding and reviewing the same. A systematic review was conducted to elucidate the clinical findings, laboratory parameters, treatment and outcomes of individuals with myocarditis after COVID-19 vaccination after registering with PROSPERO. Electronic databases including MEDLINE, EMBASE, PubMed, LitCovid, Scopus, ScienceDirect, Cochrane Library, Google Scholar and Web of Science were searched. A total of 85 articles encompassing 2184 patients were analysed. It was a predominantly male (73.4%) and young population (mean age: 25.5 ± 14.2 years) with most having taken an mRNA-based vaccine (99.4%). The mean duration from vaccination to symptom onset was 4.01 ± 6.99 days. Chest pain (90.1%), dyspnoea (25.7%) and fever (11.9%) were the most common symptoms. Only 2.3% had comorbidities. CRP was elevated in 83.3% and cardiac troponin in 97.6% patients. An abnormal ECG was reported in 979/1313 (74.6%) patients with ST-segment elevation being most common (34.9%). Echocardiographic data were available for 1243 patients (56.9%), of whom 288 (23.2%) had reduced left ventricular ejection fraction. Non-steroidal antiinflammatory drugs (76.5%), steroids (14.1%) followed by colchicine (7.3%) were used for treatment. Only 6 patients died among 1317 of whom data were available. Myocarditis following COVID-19 vaccination is often mild, seen more commonly in young healthy males and is followed by rapid recovery with conservative treatment. The emergence of this adverse event calls for harmonizing case definitions and definite treatment guidelines, which require wider research.
Topics: Humans; Male; Child; Adolescent; Young Adult; Adult; Female; COVID-19; COVID-19 Vaccines; Myocarditis; SARS-CoV-2; Stroke Volume; Ventricular Function, Left
PubMed: 35238384
DOI: 10.1093/qjmed/hcac064 -
ESC Heart Failure Aug 2023The aim of the meta-analysis was to generate a more comprehensive understanding of the HFA-PEFF score in the diagnosis of heart failure with preserved ejection fraction... (Meta-Analysis)
Meta-Analysis Review
The aim of the meta-analysis was to generate a more comprehensive understanding of the HFA-PEFF score in the diagnosis of heart failure with preserved ejection fraction (HFpEF) and to pose clues in the field of scientific and clinical practice. Electronic databases of PubMed, Web of Science, Cochrane Library, and Embase were systematically searched. Studies investigating the use of the HFA-PEFF score to diagnose HFpEF were included. Pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative Likelihood Ratio (NLR), diagnostic odds ratio (DOR), area under the curve of summary receiver operating characteristic, and superiority index were calculated. Five studies with 1521 participants were included in this meta-analysis. In the pooled analysis of the 'Rule-out' approach, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.98 (0.94, 1.00), 0.33 (0.08, 0.73), 1.5 (0.8, 2.5), 0.05 (0.02, 0.17), and 28 (6, 127). In the pooled analysis of the 'Rule-in' approach, the pooled sensitivity and specificity, PLR, NLR, and DOR were 0.69 (0.62, 0.75), 0.87 (0.64, 0.96), 5.5 (1.8, 16.9), 0.35 (0.30, 0.41), and 16 (5, 50). This meta-analysis indicates that the HFA-PEFF algorithm showed acceptable specificity and sensitivity for the diagnosis and exclusion of HFpEF. More relevant studies on the diagnostic validity of the HFA-PEFF score are needed in the future.
Topics: Humans; Heart Failure; Stroke Volume; Sensitivity and Specificity; ROC Curve; Algorithms
PubMed: 37292053
DOI: 10.1002/ehf2.14421 -
Four-dimensional flow cardiovascular magnetic resonance in tetralogy of Fallot: a systematic review.Journal of Cardiovascular Magnetic... May 2021Patients with repaired Tetralogy of Fallot (rTOF) often develop cardiovascular dysfunction and require regular imaging to evaluate deterioration and time interventions... (Review)
Review
BACKGROUND
Patients with repaired Tetralogy of Fallot (rTOF) often develop cardiovascular dysfunction and require regular imaging to evaluate deterioration and time interventions such as pulmonary valve replacement. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) enables detailed assessment of flow characteristics in all chambers and great vessels. We performed a systematic review of intra-cardiac 4D flow applications in rTOF patients, to examine clinical utility and highlight optimal methods for evaluating rTOF patients.
METHODS
A comprehensive literature search was undertaken in March 2020 on Google Scholar and Scopus. A modified version of the Critical Appraisal Skills Programme (CASP) tool was used to assess and score the applicability of each study. Important clinical outcomes were assessed including similarities and differences.
RESULTS
Of the 635 articles identified, 26 studies met eligibility for systematic review. None of these were below 59% applicability on the modified CASP score. Studies could be broadly classified into four groups: (i) pilot studies, (ii) development of new acquisition methods, (iii) validation and (vi) identification of novel flow features. Quantitative comparison with other modalities included 2D phase contrast CMR (13 studies) and echocardiography (4 studies). The 4D flow study applications included stroke volume (18/26;69%), regurgitant fraction (16/26;62%), relative branch pulmonary artery flow(4/26;15%), systolic peak velocity (9/26;35%), systemic/pulmonary total flow ratio (6/26;23%), end diastolic and end systolic volume (5/26;19%), kinetic energy (5/26;19%) and vorticity (2/26;8%).
CONCLUSIONS
4D flow CMR shows potential in rTOF assessment, particularly in retrospective valve tracking for flow evaluation, velocity profiling, intra-cardiac kinetic energy quantification, and vortex visualization. Protocols should be targeted to pathology. Prospective, randomized, multi-centered studies are required to validate these new characteristics and establish their clinical use.
Topics: Heart Ventricles; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Predictive Value of Tests; Prospective Studies; Retrospective Studies; Tetralogy of Fallot
PubMed: 34011372
DOI: 10.1186/s12968-021-00745-0 -
Heart Failure Reviews Jul 2023Several guidelines have recommended the use of angiotensin receptor neprilysin inhibitors (ARNIs) as replacement for angiotensin-converting enzyme inhibitors in the... (Meta-Analysis)
Meta-Analysis Review
Efficacy and safety profile of angiotensin receptor neprilysin inhibitors in the management of heart failure: a systematic review and meta-analysis of randomized controlled trials.
Several guidelines have recommended the use of angiotensin receptor neprilysin inhibitors (ARNIs) as replacement for angiotensin-converting enzyme inhibitors in the management of heart failure. Till date, there are no reviews done that comprehensively cover different aspects of efficacy and safety parameters. Hence, we have performed a comprehensive systematic review and meta-analysis on role of ARNIs for the management of heart failure patients. Searches were done in Embase, Scopus, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, PubMed Central, Cochrane Library, MEDLINE, Google Scholar, ScienceDirect and Clinicaltrials.gov until June 2022. Risk of bias assessment was done with Cochrane's risk of bias tool. Meta-analysis was carried out using random-effects model. Pooled standardized mean difference (SMD)/mean difference (MD) and/or risk ratio (RR) with 95% confidence intervals (CIs) was reported. In total, we analysed 34 studies, with almost all of them had a high risk of bias. Pooled RR was 0.88 (95% CI: 0.82-0.95) for all-cause mortality, 0.84 (95% CI: 0.77-0.92) for cardiovascular mortality and 0.78 (95% CI: 0.70-0.87) for hospitalization. Pooled MD was 3.74 (95% CI: 1.93-5.55) for left ventricular ejection fraction, -2.16 (95% CI: -3.58 to -0.74) for left atrial volume index, -3.80 (95% CI: -6.60 to -1.00) for left ventricular end-diastolic dimension and -1.16 (95% CI: -1.98 to -0.35) for E/E' ratio. Regarding adverse events, pooled RR was 1.55 (95% CI: 1.31-1.85) for symptomatic hypotension, 0.93 (95% CI: 0.78-1.11) for worsening renal function, 1.09 (95% CI: 0.94-1.26) for hyperkalaemia and 1.29 (95% CI: 0.67-2.50) for angioedema. ARNIs had beneficial efficacy and safety profile on the management of heart failure especially patients with reduced ejection fraction.
Topics: Humans; Neprilysin; Stroke Volume; Ventricular Function, Left; Randomized Controlled Trials as Topic; Heart Failure; Angiotensin Receptor Antagonists
PubMed: 36184714
DOI: 10.1007/s10741-022-10273-3 -
Frontiers in Pharmacology 2022This study aimed to clarify the efficacy and safety of Xinbao pill (XBP) as an adjunctive treatment for chronic heart failure (CHF). Randomized controlled trials... (Review)
Review
This study aimed to clarify the efficacy and safety of Xinbao pill (XBP) as an adjunctive treatment for chronic heart failure (CHF). Randomized controlled trials (RCTs) on the efficacy and safety of XBP in the treatment of CHF were searched from the six databases. The risk of bias assessment tool recommended by Cochrane Handbook 5.1 were used to assess the methodological quality of the included studies. RevMan 5.3 software was used for meta-analysis. The subgroup and sensitivity analyses were also performed. The grading recommendations assessment, development, and evaluation (GRADE) technique were used to assess the evidence's certainty. Nine RCTs with a total of 882 patients were identified in this study. The meta-analysis demonstrated that XBP as adjunctive therapy was superior to conventional medicine alone for the treatment of CHF in improving the left ventricular ejection fraction (LVEF; MD = 5.34; 95% CI 4.68 to 5.99; < 0.001), the total effective rate (RR = 1.21; 95% CI, 1.14 to 1.29; < 0.001), the cardiac output (MD = 0.56; 95% CI 0.42 to 0.70; < 0.001), the stroke volume (MD = 3.42; 95% CI 2.03 to 4.81; < 0.001) and the 6-min walking distance (6-MWD; MD = 31.95; 95% CI 21.83 to 42.06; < 0.001), meanwhile reducing the left ventricular end-diastolic diameter (LVEDD; MD = -3.22; 95% CI -4.03 to -2.42; < 0.001) and left ventricular end-systolic dimension (LVESD; MD = -2.93; 95% CI -3.80 to -2.06; < 0.001). Regarding safety, a total of 2.4% (11/456) adverse reactions occurred in the XBP groups while 3.9% (18/456) in the control group. The outcomes' evidentiary quality ranged from "very low" to "moderate". This study indicated that XBP as adjunctive therapy combined with conventional medicine seemed to be safe and more effective than conventional medicine alone in treating CHF. However, due to the poor methodological quality of the included RCTs, further well-designed RCTs are required to confirm the efficacy and safety of XBP.
PubMed: 35308242
DOI: 10.3389/fphar.2022.846867 -
Clinical Cardiology Jun 2022Left atrial (LA) appendage closure (LAAC) is effective in patients with atrial fibrillation who are not candidates for long-term anticoagulation. However, the impact of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Left atrial (LA) appendage closure (LAAC) is effective in patients with atrial fibrillation who are not candidates for long-term anticoagulation. However, the impact of LAAC on LA function is unknown. The aim of this study is to evaluate the impact of LAAC on atrial function.
METHODS
This meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the effect of LAAC on the LA function from inception to November 20, 2021. The standardized mean difference (SMD) was calculated from the means and standard deviations.
RESULTS
Of 247 studies initially identified, 8 studies comprising 260 patients were included in the final analysis. There was a significant increase in LA emptying fraction following LAAC compared with preoperative function (SMD: 0.53; 95% confidence interval [CI]: 0.04-1.01; p = .03; I = 75%). In contrast, there were no significant differences in LA volume (SMD: -0.07; 95% CI: -0.82-0.69; p = .86; I = 92%) peak atrial longitudinal strain (SMD: 0.50; 95% CI: -0.08-1.08; p = .09; I = 89%), peak atrial contraction strain (SMD: 0.38; 95% CI: -0.22-0.99; p = .21; I = 81%), strain during atrial contraction (SMD: -0.24; 95% CI: -0.61-0.13; p = .20; I = 0%), strain during ventricular systole (SMD: 0.47; 95% CI: -0.32-1.27; p = .24; I = 89%), strain during ventricular diastole (SMD: 0.09; 95% CI: -0.32-0.51; p = .66; I = 65%).
CONCLUSION
LAAC is associated with improvement in the left atrial emptying fraction, but did not significantly influence other parameters.
Topics: Atrial Appendage; Atrial Fibrillation; Atrial Function, Left; Cardiac Surgical Procedures; Humans; Stroke; Treatment Outcome
PubMed: 35366380
DOI: 10.1002/clc.23824 -
Frontiers in Pharmacology 2022Dupilumab is a human monoclonal antibody directed against the alpha subunit of the interleukin-4 receptor and inhibits the signaling of IL-4 and IL-13. It is approved...
Dupilumab is a human monoclonal antibody directed against the alpha subunit of the interleukin-4 receptor and inhibits the signaling of IL-4 and IL-13. It is approved for treating asthma and other type-2 inflammatory diseases. There is a conflict in the literature regarding the safety and efficacy of dupilumab. Thus, we aimed to assess the safety and efficacy of dupilumab in patients with moderate to severe asthma. Six databases (PubMed, Embase, Scopus, Web of Science, Cochrane library, and clinicaltrials.gov registry) were searched until January 2022. We included randomized controlled trials that compared dupilumab with the placebo in moderate to severe asthma patients. We extracted the data at 12 and 24 weeks and analyzed them using review manager 5.4. Thirteen trials were included. Dupilumab significantly improved the forced expiratory volume in 1 s, asthma control questionnaire score, the fraction of exhaled nitric oxide level, and immunoglobulin E level at 12 and 24 weeks ( < 0.05). However, it was associated with increased blood eosinophils at 12 and 24 weeks. Dupilumab was generally a safe agent for asthmatic patients. It showed no significant difference compared with the placebo regarding most adverse events. Dupilumab improves pulmonary function and reduces local and systemic inflammatory markers with minimal adverse events in patients with moderate to severe asthma.
PubMed: 36263132
DOI: 10.3389/fphar.2022.992731 -
PloS One 2017Cardiac resynchronization therapy(CRT) has been recommended as a standard treatment for patients with advanced heart failure. However, some studies have reported... (Meta-Analysis)
Meta-Analysis Review
The impact of gender difference on clinical and echocardiographic outcomes in patients with heart failure after cardiac resynchronization therapy: A systematic review and meta-analysis.
BACKGROUND
Cardiac resynchronization therapy(CRT) has been recommended as a standard treatment for patients with advanced heart failure. However, some studies have reported different clinical and echocardiographic outcomes between male and female patients who received CRT. This Meta-analysis is to determine whether gender difference has any significant impact on clinical and echocardiographic outcomes in patients with heart failure after CRT.
METHODS AND RESULTS
PubMed, Embase, and the Cochrane library database were searched. A total of 149,259 patients in 11 studies were identified. Our analysis demonstrated that women showed lower all-cause mortality than men after CRT (odds ratio[OR] 0.50, 95% confidence interval [CI] 0.36 to 0.70). No significant difference was observed in the increment of New York Heart Association (NYHA) functional class(standard mean difference[SMD] -0.07,95% CI -0.15 to 0.01), 6-minitue walk distance (6-MWD) (SMD -0.05, 95% CI -0.07 to 0.17), and quality of life (QoL) (SMD -0.10, 95% CI -0.23 to 0.03). With respect to the echocardiographic parameters, women exhibited statistically significant improvement in left ventricular ejection fraction (LVEF) (SMD 0.25,95% CI 0.07 to 0.43), and decrement of left ventricular end diastolic diameter (LVEDD) (SMD -0.27, 95% CI -0.39 to -0.25) as compared with men. No significant difference was observed in left ventricular end diastolic volume (LVEDV) (SMD -0.08, 95% CI -0.28 to 0.08) and left ventricular end systolic volume (LVESV) (SMD -0.16, 95% CI -0.40 to 0.09) between men and women.
CONCLUSION
Women seem to obtain greater benefits from CRT both in clinical and echocardiographic outcomes compared with men. But as this gender superiority could be observed only during long-term follow-up periods, further studies are needed to elucidate exact reasons for this phenomenon.
Topics: Cardiac Resynchronization Therapy; Electrocardiography; Heart Failure; Humans; Quality of Life; Sex Characteristics; Treatment Outcome
PubMed: 28453545
DOI: 10.1371/journal.pone.0176248 -
Monaldi Archives For Chest Disease =... Oct 2016Exercise training induces physical adaptations for heart failure patients with systolic dysfunction but less is known about those patients with preserved ejection... (Meta-Analysis)
Meta-Analysis Review
Exercise training induces physical adaptations for heart failure patients with systolic dysfunction but less is known about those patients with preserved ejection fraction. This study's aims were to establish if exercise training produces changes in peak VO2 and related measures, quality of life, general health and diastolic function in heart failure patients with preserved ejection fraction (HFpEF). We conducted a MEDLINE search (1985 to September 1, 2015), for exercise based rehabilitation trials in heart failure, using search terms 'exercise training, heart failure with preserved ejection fraction, heart failure with normal ejection fraction, peak VO2 and diastolic heart dysfunction'. Eight intervention studies were included providing a total of 174 exercising subjects and 143 control subjects, a total of 317 participants. Peak VO2 increased by a mean difference (MD) 2.08 mL kg-1 min-1 (95% C.I. 1.51 to 2.65, p<0.00001) in exercise training versus sedentary control, equating to a 17% improvement from baseline. VE/VCO2 slope was not different between groups, MD -3.10 mL kg-1 min-1 (95% C.I. -7.47 to 1.27, p=0.16); maximum heart rate was significantly increased in exercise groups, MD 3.46 bpm (95% C.I. 2.41 to 4.51, p<0.00001); 6 Minute Walk Distance (6MWT) MD 32.1m (95% C.I. 17.2 to 47.1, p<0.0001); diastolic function; the ratio of early to late filling (E/A ratio) was improved after exercise training MD 0.07 (95% C.I. 0.02 to 0.12, p=0.006); as was filling pressure E/E' ratio MD -2.38 (95% C.I. -3.47 to -1.28, p<0.0001); Deceleration time (DT) MD -13.2 msec (95% C.I. -19.8 to -6.5, p=0.0001); Minnesota Living with Heart Failure Questionnaire (MLHFQ) MD -6.77 (95% C.I. -9.70 to -3.84, p<0.00001); Short Form (36) Health Survey MD 11.38 (95% C.I. 5.28 to 17.48, p=0.0003). In 3222 patient-hours of training, not a single death was directly attributable to exercise. Exercise training appears to effect several health-related improvements in people with heart failure and preserved ejection fraction.
Topics: Exercise Test; Exercise Therapy; Exercise Tolerance; Heart Failure; Heart Rate; Humans; Quality of Life; Stroke Volume
PubMed: 27748473
DOI: 10.4081/monaldi.2016.759