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Heart and Vessels Feb 2022Chronic myocarditis is a prolonged inflammatory condition in the myocardium and its histological manifestation is defined by the presence of an inflammatory infiltrate.... (Meta-Analysis)
Meta-Analysis
Chronic myocarditis is a prolonged inflammatory condition in the myocardium and its histological manifestation is defined by the presence of an inflammatory infiltrate. Chronic myocarditis has not been well known and its treatment of chronic myocarditis has not been established. Primary outcome of this study was to assess the efficacy of immunomodulatory treatment in addition to conventional treatment, and secondary outcomes were to clarity the prognosis of natural history of chronic myocarditis and incidence of chronic myocarditis in patients with dilated cardiomyopathy (DCM). We searched for studies in Medline, Embase, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi published between January 1946 and June 2020. Sixteen studies met the inclusion criteria. A meta-analysis revealed that patients receiving immunomodulatory treatment showed an improvement in left ventricular ejection fraction after immunomodulatory treatment compared to the control group (hazard ratio, 16.65; confidence interval, 4.55-28.74; p = 0.007). Five-year survival rate of the patients with inflammatory DCM (iDCM) and DCM was 52.7-70.3% and 51.9-91.1%, respectively. Moreover, 51.5%-62.7% of patients with DCM met the criteria of iDCM. Our systematic review revealed that patients with chronic myocarditis had poor prognosis and immunomodulatory treatment was significantly effective in addition to conventional treatment.
Topics: Biopsy; Cardiomyopathy, Dilated; Humans; Myocarditis; Myocardium; Stroke Volume; Ventricular Function, Left
PubMed: 34365565
DOI: 10.1007/s00380-021-01914-y -
Frontiers in Pharmacology 2022Qili Qiangxin Capsule (QQC), a Chinese patent medicine, is clinically effective in treating dilated cardiomyopathy (DCM). However, the meta-analysis of QCC combined...
Qili Qiangxin Capsule (QQC), a Chinese patent medicine, is clinically effective in treating dilated cardiomyopathy (DCM). However, the meta-analysis of QCC combined with conventional western medicine (CWM) on DCM remains unexplored. This study aimed to systematically evaluate the efficacy and safety of QCC in the treatment of DCM. Searched the studies of the combination of QQC and CWM in the treatment of DCM, from databases like PubMed, Cochrane Library, Web of Science, Wan Fang Databases, Chinese Biomedical Literature Database, China Science and Technology Journal Database, China National Knowledge Infrastructure, prior to 15 January 2022. Two reviewers respectively regulated research selection, data extraction, and risk of bias assessment. Review Manager Software 5.4 was used for meta-analysis. Furthermore, GRADE pro3.6.1 software was selected to grade the current evidence in our findings. This meta-analysis has been registered in PROSPERO (CRD42022297906). There were 35 studies pertaining to 3,334 patients included. The meta-analysis showed compared with CWM alone, the combination therapy had significant advantages in improving the clinical efficiency rate (RR = 1.24, 95% CI: 1.19 to 1.29, < 0.00001), 6 min walking distance (6MWD) (MD = 41.93, 95%CI: 39.82 to 44.04, < 0.00001), superior in ameliorating the left ventricular ejection fraction (LVEF) (MD = 5.73, 95%CI: 4.70 to 6.77, < 0.00001), left ventricular end-diastolic dimension (LVEDD) (MD = -4.09, 95%CI: -4.91 to -3.27), < 0.00001), left ventricular end-systolic diameter (LVESD) (MD = -4.73, 95%CI: -5.63 to -3.84), < 0.00001) and BNP (MD = -101.09, 95%CI: -132.99 to -69.18), < 0.00001), and also superior in reducing hypersensitive-C-Reactive Protein (hs-CRP) (MD = -3.78, 95%CI: -4.35 to -3.21), < 0.00001), Interleukin- 6 (IL-6) (MD = -25.92, 95%CI: -31.35 to -20.50), < 0.00001), tumor necrosis factor-α (TNF-α) (MD = -5.04, 95%CI: -6.13 to -3.95), < 0.00001), high mobility group protein B1 (HMGB1) (MD = -4.34, 95%CI: -5.22 to -3.46), < 0.00001), and adverse reactions (ARs) (RR = 0.70, 95%CI: 0.51-0.97), = 0.03). The GRADE evidence quality rating presented with moderate or low quality of evidence for the available data. Compared with the control group, QQC combined with CWM may be effective in treating DCM. However, the conclusion of this study must be interpreted carefully due to the inferior quality and ambiguity of bias in the included trials. : https://www.crd.york.ac.uk/prospero, identifier [CRD42022297906].
PubMed: 35571117
DOI: 10.3389/fphar.2022.893602 -
JACC. Heart Failure Jun 2024Acute myocarditis is an inflammatory condition that may precede the development of dilated or arrhythmogenic cardiomyopathy. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Acute myocarditis is an inflammatory condition that may precede the development of dilated or arrhythmogenic cardiomyopathy.
OBJECTIVES
The aim of this study was to investigate the reported prevalence of pathogenic or likely pathogenic (P/LP) variants in cardiomyopathy-associated genes in patients with acute myocarditis.
METHODS
For this systematic review and meta-analysis, the PubMed and Embase databases were searched on March 4, 2023. Observational studies evaluating the prevalence of P/LP variants in cardiomyopathy-associated genes in patients with acute myocarditis were included. Studies were stratified into adult and pediatric age groups and for the following scenarios: 1) complicated myocarditis (ie, presenting with acute heart failure, reduced left ventricular ejection fraction, or life-threatening ventricular arrhythmias); and 2) uncomplicated myocarditis. The study was registered with the International Prospective Register of Systematic Reviews (CRD42023408668) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
Of 732 studies identified, 8 met the inclusion criteria, providing data for 586 patients with acute myocarditis. A total of 89 P/LP variants in cardiomyopathy-associated genes were reported in 85 patients. For uncomplicated myocarditis, the pooled prevalence was 4.2% (95% CI: 1.8%-7.4%; I = 1.4%), whereas for complicated myocarditis, the pooled prevalence was 21.9% (95% CI: 14.3%-30.5%; I = 38.8%) and 44.5% (95% CI: 22.7%-67.4%; I = 52.8%) in adults and children, respectively. P/LP variants in desmosomal genes were predominant in uncomplicated myocarditis (64%), whereas sarcomeric gene variants were more prevalent in complicated myocarditis (58% in adults and 71% in children).
CONCLUSIONS
Genetic variants are present in a large proportion of patients with acute myocarditis. The prevalence of genetic variants and the genes involved vary according to age and clinical presentation.
Topics: Humans; Myocarditis; Acute Disease; Prevalence; Cardiomyopathies
PubMed: 38573261
DOI: 10.1016/j.jchf.2024.02.012 -
American Journal of Cardiovascular... Nov 2022Previous research demonstrated that short-term treatment of dilated cardiomyopathy with thyroid hormones exerted beneficial hemodynamic effects when added to standard... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous research demonstrated that short-term treatment of dilated cardiomyopathy with thyroid hormones exerted beneficial hemodynamic effects when added to standard anti-heart failure therapy, but it remains debatable whether thyroid hormones can be used to treat dilated cardiomyopathy. Therefore, we conducted a meta-analysis to evaluate the effectiveness and safety of thyroid hormone treatment in patients with dilated cardiomyopathy.
METHODS
The Cochrane Clinical Trials Registry database, PubMed, Embase, Chinese Biomedical Literature Database, China Academic Journals full-text database, Wanfang Database, China Science and Technology Journal Database, and Clinical Trials.gov were screened through 15 October, 2021. Randomized controlled clinical trials were selected based on study inclusion criteria. Two independent reviewers extracted the data and assessed study bias using the Cochrane risk of bias tool. For the data synthesis, the weighted mean difference was calculated using baseline and post-thyroid hormone treatment data. Random-effects models were used for the meta-analysis. The primary outcomes were left ventricular ejection fraction after a minimum follow-up of 1 week and adverse events.
RESULTS
Ten of the 1149 published reports met the inclusion criteria (N = 608 randomized individuals). After reasonable use of thyroid hormone therapy, left ventricular ejection fraction increased (weighted mean difference, 3.94; 95% confidence interval 3.06-4.81; I = 0.00%), cardiac output increased, and left ventricular end-diastolic diameter decreased, but left ventricular mass index and thyroid function were unaffected. Adverse events were reported in the intervention group of two studies. The ten studies demonstrated a low risk of bias.
CONCLUSIONS
Adding thyroid hormones to conventional anti-heart failure treatment in patients with DCM appears to be an effective and well tolerated therapeutic option.
CLINICAL TRIAL REGISTRATION
The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42021286043).
Topics: Humans; Cardiomyopathy, Dilated; Stroke Volume; Thyroid Gland; Ventricular Function, Left; Heart Failure; Thyroid Hormones
PubMed: 36045258
DOI: 10.1007/s40256-022-00548-3 -
Circulation. Genomic and Precision... Feb 2022Variants in the gene, that encodes the cardiac sodium channel, Nav1.5, are associated with a highly arrhythmogenic form of dilated cardiomyopathy (DCM). Our aim was to...
BACKGROUND
Variants in the gene, that encodes the cardiac sodium channel, Nav1.5, are associated with a highly arrhythmogenic form of dilated cardiomyopathy (DCM). Our aim was to review the phenotypes, natural history, functional effects, and treatment outcomes of DCM-associated rare variants.
METHODS
A systematic review of reported DCM-associated rare variants was undertaken using PubMed and Embase.
RESULTS
Eighteen rare variants in 29 families with DCM (173 affected individuals) were identified. Eleven variants had undergone experimental evaluation, with 7 of these resulting in increased sustained current flow during the action potential (eg, increased window current) and at resting membrane potentials (eg, creation of a new gating pore current). These variants were located in transmembrane voltage-sensing domains and had a consistent phenotype characterized by frequent multifocal narrow and broad complex ventricular premature beats (VPB; 72% of affected relatives), ventricular arrhythmias (33%), atrial arrhythmias (32%), sudden cardiac death (13%), and DCM (56%). This VPB-predominant phenotype was not seen with 1 variant that increased late sodium current, or with variants that reduced peak current density or had mixed effects. In the latter groups, affected individuals mainly showed sinus node dysfunction, conduction defects, and atrial arrhythmias, with infrequent VPB and ventricular arrhythmias. DCM did not occur in the absence of arrhythmias for any variant. Twelve studies (23 total patients) reported treatment success in the VPB-predominant cardiomyopathy using sodium channel-blocking drug therapy.
CONCLUSIONS
variants can present with a diverse spectrum of primary arrhythmic features. A majority of DCM-associated variants cause a multifocal VPB-predominant cardiomyopathy that is reversible with sodium channel blocking drug therapy. Early recognition of the distinctive phenotype and prompt genetic testing to identify variant carriers are needed. Our findings have implications for interpretation and management of variants found in DCM patients with and without arrhythmias.
Topics: Arrhythmias, Cardiac; Cardiac Conduction System Disease; Cardiomyopathy, Dilated; Humans; NAV1.5 Voltage-Gated Sodium Channel; Phenotype
PubMed: 34949099
DOI: 10.1161/CIRCGEN.121.003432 -
Heart (British Cardiac Society) Jan 2023To conduct a systematic review of observational studies on methamphetamine-associated heart failure (MethHF) . (Review)
Review
OBJECTIVE
To conduct a systematic review of observational studies on methamphetamine-associated heart failure (MethHF) .
METHODS
Six databases were searched for original publications on the topic. Title/abstract and included full-text publications were reviewed in duplicate. Data extraction and critical appraisal for risk of bias were performed in duplicate.
RESULTS
Twenty-one studies are included in the final analysis. Results could not be combined because of heterogeneity in study design, population, comparator, and outcome assessment. Overall risk of bias is moderate due to the presence of confounders, selection bias and poor matching; overall certainty in the evidence is very low. MethHF is increasing in prevalence, affects diverse racial/ethnic/sociodemographic groups with a male predominance; up to 44% have preserved left-ventricular ejection fraction. MethHF is associated with significant morbidity including worse heart failure symptoms compared with non-methamphetamine related heart failure. Female sex, methamphetamine abstinence and guideline-directed heart failure therapy are associated with improved outcomes. Chamber dimensions on echocardiography and fibrosis on biopsy predict the extent of recovery after abstinence.
CONCLUSIONS
The increasing prevalence of MethHF with associated morbidity underscores the urgent need for well designed prospective studies of people who use methamphetamine to accurately assess the epidemiology, clinical features, disease trajectory and outcomes of MethHF. Methamphetamine abstinence is an integral part of MethHF treatment; increased availability of effective non-pharmacological interventions for treatment of methamphetamine addiction is an essential first step. Availability of effective pharmacological treatment for methamphetamine addiction will further support MethHF treatment. Using harm reduction principles in an integrated addiction/HF treatment programme will bolster efforts to stem the increasing tide of MethHF.
Topics: Humans; Male; Female; Methamphetamine; Stroke Volume; Ventricular Function, Left; Prospective Studies; Heart Failure
PubMed: 36456204
DOI: 10.1136/heartjnl-2022-321610 -
Kardiologiia Oct 2022Aim This study was aimed at performing a systematic review and meta-analysis to investigate the prognostic role of left ventricular (LV) myocardial strain variables... (Meta-Analysis)
Meta-Analysis
Aim This study was aimed at performing a systematic review and meta-analysis to investigate the prognostic role of left ventricular (LV) myocardial strain variables as determined by magnetic-resonance imaging in non-ischemic dilated cardiomyopathy.Material and methods A search was performed in PubMed (MEDLINE), Google Scholar, and EMBASE databases for studies on the prognostic role of LV myocardial strain based on MR feature-tracking in non-ischemic dilated cardiomyopathy. Uncorrected odds ratio (OR) values reported by the studies where similar evaluation criteria of myocardial strain were available, were combined for a meta-analysis.Results Nine studies were selected from 351 publications for this systematic review and meta-analysis. The analysis included a totality of 2139 patients (mean age, 52.3 years; mean follow-up duration, 42.5 months). The meta-analysis showed that the worsening of the LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) was associated with increased risk of major adverse cardiovascular events (MACE): OR, 1.13 per each % of GLS; 95 % CI: 1.050-1.225; p=0.001; OR, 1.16 per each % of GCS; 95 % CI: 1.107-1.213; p<0.0001; OR, 0.95 per each % of GRS; 95 % CI: 0.92-0.97; p<0.0001.Conclusion The LV GLS, GCS, and GRS variables by MR feature-tracking data are powerful predictors for the development of MACE. Evaluation of myocardial strain can be used as an effective instrument for risk stratification in patients with non-ischemic dilated cardiomyopathy.
Topics: Humans; Middle Aged; Cardiomyopathy, Dilated; Magnetic Resonance Imaging, Cine; Ventricular Function, Left; Prognosis; Magnetic Resonance Imaging
PubMed: 36384407
DOI: 10.18087/cardio.2022.10.n2034 -
Scientific Reports Aug 2023Risk stratification based mainly on the impairment of left ventricular ejection fraction has limited performance in patients with nonischemic dilated cardiomyopathy... (Meta-Analysis)
Meta-Analysis
Risk stratification based mainly on the impairment of left ventricular ejection fraction has limited performance in patients with nonischemic dilated cardiomyopathy (NIDCM). Evidence is rapidly growing for the impact of myocardial scar identified by late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMR) on cardiovascular events. We aim to assess the prognostic value of LGE on long-term arrhythmic and mortality outcomes in patients with NIDCM. PubMed, Scopus, and Cochrane databases were searched from inception to January 21, 2022. Studies that included disease-specific subpopulations of NIDCM were excluded. Data were independently extracted and combined via random-effects meta-analysis using a generic inverse-variance strategy. Data from 60 studies comprising 15,217 patients were analyzed with a 3-year median follow-up. The presence of LGE was associated with major ventricular arrhythmic events (pooled OR: 3.99; 95% CI 3.08, 5.16), all-cause mortality (pooled OR: 2.14; 95% CI 1.81, 2.52), cardiovascular mortality (pooled OR 2.83; 95% CI 2.23, 3.60), and heart failure hospitalization (pooled OR: 2.53; 95% CI 1.78, 3.59). Real-world evidence suggests that the presence of LGE on CMR was a strong predictor of adverse long-term outcomes in patients with NIDCM. Scar assessment should be incorporated as a primary determinant in the patient selection criteria for primary prophylactic implantable cardioverter-defibrillator placement.
Topics: Humans; Cardiomyopathy, Dilated; Gadolinium; Cicatrix; Contrast Media; Stroke Volume; Ventricular Function, Left; Magnetic Resonance Imaging
PubMed: 37612359
DOI: 10.1038/s41598-023-41087-4 -
Phytomedicine : International Journal... Feb 2023Shenmai Injection (SMI), a Chinese herbal injection, is widely used in China for the adjuvant treatment of patients with dilated cardiomyopathy (DCM), yet its clinical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Shenmai Injection (SMI), a Chinese herbal injection, is widely used in China for the adjuvant treatment of patients with dilated cardiomyopathy (DCM), yet its clinical efficacy and safety remain controversial.
PURPOSE
The aim of this study was to systematically evaluate the efficacy and safety of SMI in the treatment of DCM.
METHODS
Randomised controlled trials (RCTs) of SMI in the treatment of DCM were searched for and collected from the PubMed, EMBASE, Cochrane Library, SinoMed, Wan Fang, CNKI, and VIP databases between the dates of establishment of each database and July 1, 2022. The methodological quality of the included studies was assessed, while the risk of bias was based on the Cochrane Collaboration tool. All data were analysed using the R software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the quality of the evidence.
RESULTS
In total, 16 RCTs, including 1,455 participants, were examined in this study. Evidence showed that the combination of SMI treatment and conventional treatment appears to significantly increase the clinical efficacy rate (OR=3.65, 95%CI (2.52, 5.28), p < 0.01), improve cardiac function (e.g. increase left ventricular ejection fraction (LVEF) (MD=5.31, 95%CI (4.21, 6.40), p < 0.01), decrease left ventricular end-diastolic dimension (LVEDD) (MD=-4.57, 95% CI (-7.10, -2.04); p < 0.01) and left ventricular end-systolic diameter (LVESD) (MD=-2.46, 95% CI (-3.60, -1.33); p < 0.01), decrease brain natriuretic peptide (BNP) (MD=-215.85, 95% CI (-241.61, -190.10); p < 0.01) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (MD=-504.42, 95% CI (-687.73, -321.10); p < 0.01), and increase 6-min walk distance (6MWD) (MD=114.08, 95% CI (42.32, 185.85); p < 0.01).In addition, no serious adverse effects associated with SMI were observed during the study period, thus suggesting that SMI is safe. However, the quality of evidence for these results was rated as "very low" to "low", mainly due to the poor methodological quality of the included RCTs, the small sample size, the high heterogeneity, and potential publication bias.
CONCLUSION
In the present work, we provide evidence that combined SMI therapy is beneficial and safe for improving cardiac function in patients with DCM. However, due to limitations posed by the low methodological quality of the included trials, more rigorous and high-quality RCTs are needed to provide solid evidence.
Topics: Humans; Cardiomyopathy, Dilated; Natriuretic Peptide, Brain; Drugs, Chinese Herbal; Drug Combinations; Randomized Controlled Trials as Topic
PubMed: 36608499
DOI: 10.1016/j.phymed.2022.154630 -
The International Journal of... Dec 2022Cardiac magnetic resonance (CMR) derived left ventricular global longitudinal strain (LV-GLS) for evaluating dilated cardiomyopathy patients has been addressed in... (Meta-Analysis)
Meta-Analysis
Prognostic value of cardiac magnetic resonance derived global longitudinal strain analysis in patients with ischaemic and non-ischaemic dilated cardiomyopathy: a systematic review and meta-analysis.
Cardiac magnetic resonance (CMR) derived left ventricular global longitudinal strain (LV-GLS) for evaluating dilated cardiomyopathy patients has been addressed in studies with contradictory results. We therefore performed the first systematic review evaluating evidence on the prognostic value of CMR derived LV-GLS for ischaemic (IDCM) and non-ischaemic dilated cardiomyopathy (NDCM) patients. Systematic review (PROSPERO CRD42020171582) identified studies up to January 2021 that measured LV-GLS for predicting major adverse cardiac events among dilated cardiomyopathy patients. Studies were identified from MEDLINE, Embase and PubMed by two independent reviewers. 2099 studies were screened. Three prospective and three retrospective observational studies comprising of 1758 patients (29% IDCM patients; 71% NDCM patients) with a weighted mean follow up of 3 years (SD = 1 year) were identified. All six studies included mortality in the primary composite outcome. LV-GLS was associated with increase primary composite outcome among mild to moderately impaired left ventricular ejection fraction (LVEF) IDCM and NDCM patients (> 30%) in univariable and multivariable analysis. Association was lost among severely impaired LVEF patients (< 30%). From sensitivity analysis, LV-GLS showed significant association with death among NDCM patients (HR 1.27; 95% CI 1.10-1.46; p = 0.001; I = 59%) but insignificant for heart transplant outcome (HR 1.23; 95% CI 0.46-3.33; p = 0.68, I = 44%). LV-GLS threshold for effectively stratifying patients is - 12.5% to - 13.5%. LVEF in IDCM and NDCM became an insignificant prognostic marker in multivariable analysis. CMR LV-GLS shows promise as an independent predictor of mortality in IDCM and NDCM patients. However, in patients with LVEF < 30% LV-GLS may have less prognostic value.Prospero Registration: CRD42020171582.
Topics: Humans; Prognosis; Stroke Volume; Cardiomyopathy, Dilated; Retrospective Studies; Prospective Studies; Ventricular Function, Left; Predictive Value of Tests; Magnetic Resonance Spectroscopy
PubMed: 36445666
DOI: 10.1007/s10554-022-02679-9