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Saudi Pharmaceutical Journal : SPJ :... Aug 2022Although heart failure with preserved ejection fraction (HFpEF) is a serious disease, only limited options are available for its treatment. Recent studies have analyzed...
BACKGROUND
Although heart failure with preserved ejection fraction (HFpEF) is a serious disease, only limited options are available for its treatment. Recent studies have analyzed the effects of phosphodiesterase (PDE) inhibitors, especially PDE5 and PDE3 inhibitors, in patients with HFpEF, with mixed outcomes.
METHODS
We searched PUBMED and EMBASE databases up to August 2021. Randomized controlled trials (RCTs) and clinical trials that tested the effects of PDE inhibitors on patients with HFpEF were included as eligible studies. Indicators of left ventricular (LV) function, pulmonary arterial pressure (PAP), right ventricular (RV) function, exercise capacity, and quality of life (QOL) were used to evaluate the efficacy of PDE inhibitors in HFpEF.
RESULTS
Six RCTs that reported in 7 studies were included to evaluate the efficiency of PDE inhibitors on HFpEF patients. In the pooled analysis, PDE inhibitors showed insignificant changes in the ratio of early diastolic mitral inflow to annular velocities, left atrial volume index, pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR), peak oxygen uptake, 6-minute walking test distance, as well as Kansas City Cardiomyopathy Questionnaire score. However, substantial improvement was observed in the tricuspid annular plane systolic excursion (TAPSE). Additionally, the regression analysis showed that PDE inhibitor administration time is a critical factor for the decrease in PASP.
CONCLUSIONS
PDE inhibitors did not effectively improve LV function, PAP, exercise capacity, and QOL in patients with HFpEF. However, they improved RV function with significant difference, suggesting that PDE inhibitors might be a promising option for HFpEF patients with RV dysfunction.
PubMed: 36164567
DOI: 10.1016/j.jsps.2022.05.012 -
ESC Heart Failure Feb 2020To retrieve and assess the available data in the literature about the safety and efficacy of baroreflex activation therapy (BAT) in heart failure with reduced ejection... (Review)
Review
To retrieve and assess the available data in the literature about the safety and efficacy of baroreflex activation therapy (BAT) in heart failure with reduced ejection fraction (HFrEF) patients, through a rapid systematic review of clinical studies. Rapid systematic review of literature. Searched electronic databases included PubMed, EMBASE, CENTRAL, Scopus, and Web of Science using Mesh and free terms for heart failure and BAT. No language restriction was used for the searches. We included full peer reviewed publications of clinical studies (randomized or not), including patients with HFrEF undergoing BAT, with or without control group, assessing safety and efficacy outcomes. One reviewer conducted the analysis of the selected abstracts and the full-text articles, performed data extraction, and evaluated the methodological quality of the selected articles. The methodological quality was assessed according to the Cochrane Collaboration instruments. A descriptive summary of the results is provided. Of the 441 citations screened, 10 publications were included (three were only conference abstracts), reporting data from three studies. Only one study was a randomized clinical trial. Two studies reported a 6 month following, and the other study analysed outcomes up to 41 months. The procedure seems to be safe when performed by a well-trained multi-professional team. An 86% rate of system and procedure-related complication-free was reported, with no cranial nerve injuries. Improvements in New York Heart Association class of heart failure, quality of life, 6 min walk test, and hospitalization rates, as well as in muscle sympathetic nerve activity. No meta-analysis was conducted because of the lack of homogeneity across studies; the results from each study are reported individually. BAT procedure seems to be safe if appropriate training is provided. Improvements in clinical outcomes were described in all included studies. However, several limitations do not allow us to make conclusive statements on the efficacy of BAT for HFrEF. New well-designed trials are still needed.
Topics: Baroreflex; Electric Stimulation Therapy; Heart Failure; Humans; Quality of Life; Randomized Controlled Trials as Topic; Stroke Volume
PubMed: 31965746
DOI: 10.1002/ehf2.12543 -
Frontiers in Cardiovascular Medicine 2021This study was conducted in order to determine the reference values for right ventricular (RV) volumes and ejection fraction (EF) using three-dimensional...
This study was conducted in order to determine the reference values for right ventricular (RV) volumes and ejection fraction (EF) using three-dimensional echocardiography (3DE) and to identify sources of variance through a systematic review and meta-analysis. This systematic review was preregistered with the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO/) (CRD42020211002). Relevant studies were identified by searches of the PubMed, Embase, and Cochrane Library databases through October 12, 2020. Pooled reference values were calculated using the random-effects model weighted by inverse variance. Meta-regression analysis and Egger's test were used to determine the source of heterogeneity. A subgroup analysis was performed to evaluate the reference values across different conditions. The search identified 25 studies of 2,165 subjects. The mean reference values were as follows: RV end-diastolic volume, 100.71 ml [95% confidence interval (CI), 90.92-110.51 ml); RV end-systolic volume, 44.19 ml (95% CI, 39.05-49.33 ml); RV end-diastolic volume indexed, 57.01 ml/m (95% CI, 51.93-62.08 ml/m); RV end-systolic volume indexed, 25.41 ml/m (95% CI, 22.58-28.24 ml/m); and RVEF, 56.20% (95% CI, 54.59-57.82%). The sex- and age-specific reference values were assessed according to the studies reporting the values of different sexes and age distributions, respectively. In addition, the vendor- and software-specific reference values were analyzed. The meta-regression analysis revealed that sex, frame rate, pulmonary artery systolic pressure, and software packages were associated with variations in RV volumes ( < 0.05). Inter-vendor and inter-software discrepancies may explain the variability of RVEF. The reference values for RV volumes and RVEF using 3DE were assessed. The confounders that impacted the variability in RV volumes or RVEF contained the sex, frame rate, pulmonary artery systolic pressure, inter-vendor discrepancies, and inter-software discrepancies.
PubMed: 34631816
DOI: 10.3389/fcvm.2021.709863 -
Nigerian Journal of Clinical Practice May 2023The most effective treatment method for meningiomas is surgical treatment. However, complete resection of cavernous sinus meningiomas is quite difficult. The biggest...
BACKGROUND
The most effective treatment method for meningiomas is surgical treatment. However, complete resection of cavernous sinus meningiomas is quite difficult. The biggest reasons for this are; narrow surgical corridor, the optic chiasm is the close relationship between the cranial nerves and anterior cerebral and internal carotid arteries. Gamma knife radiosurgery (GKRS) may be a good option in these lesions with high mortality and morbidity.
AIM
This study aimed to evaluate and compare the early effects at a mean of 6 months and 3 years and outcomes between surgery followed by gamma knife radiosurgery (GKRS) and GKRS alone for cavernous sinus meningiomas.
METHODS
We included 20 patients with cavernous sinus meningioma treated via single fraction Leksell Gamma Knife Perfexion (Elekta Instruments; Stockholm, Sweden) between 2015 and 2018. The mean age of the patients was 54.95 (range: 32-77) years. Nine patients underwent primary surgery (for the resection of extracavernous components of the tumor) followed by GKRS (for the resection of intracavernous components of the tumor) (group A). Meanwhile, 11 patients were managed with GKRS alone (group B). The tumor volume ranged from 2.8 to 32.8 (mean: 14.76) cm3 and the isodose to the tumor margin from 10 to 13.5 (mean: 11.65) Gy.
RESULTS
In total, 20 patients were followed up at a mean time of 18.95 (range: 6-36) months. The mean Karnofsky Performance Score of the patients was 95.2%. The mean follow up times of groups A and B were 23.6 and 15 months, respectively. Meanwhile, only patients with a follow up time of at least 6 months were included in the study. The mean follow up time after GKRS in group A was 17.6 months. There was no change in the tumor volume in 15% of patients. In the remaining cases, the tumor volume decreased. The mean tumor regression rates were 82.2% in Group A and 17.7% in Group B. The tumor volume did not decrease in three patients (n = 1, group A and n = 2, group B). Cranial nerve deficits improved, worsened, and remained stable in 46.6%, 26.6%, and 26.6% of cases, respectively. The temporary morbidity rate was 10%. In group A, transient postoperative diabetes insipidus was observed in one patient and atelectasis in another. None of these complications affected the final status of patients. The mortality rate after treatment was 0%.
CONCLUSION
Volume staged GKRS is safe and effective for cavernous sinus meningioma. GKRS is effective for long term tumor growth control and has a low complication rate. Hence, it is the preferred management strategy for tumors with a suitable volume (average tumor diameter: 3 cm or volume: 10 cm3 ). In tumors with a volume of more than 10 mL and/or without a 3 mm safety margin with the optical system, it is recommended to prepare for radiosurgery by cytoreducing the tumor volume surgically. Based on our opinion, the best results were obtained by GKRS to the intracavernous.
Topics: Humans; Adult; Middle Aged; Aged; Meningioma; Meningeal Neoplasms; Radiosurgery; Cavernous Sinus; Treatment Outcome; Follow-Up Studies; Retrospective Studies
PubMed: 37357468
DOI: 10.4103/njcp.njcp_2033_21 -
Heart Failure Reviews Sep 2023In patients affected by heart failure (HF) with reduced ejection fraction (HFrEF), pharmacological treatments have been proven to alleviate symptoms and improve... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In patients affected by heart failure (HF) with reduced ejection fraction (HFrEF), pharmacological treatments have been proven to alleviate symptoms and improve prognosis, while no treatment other than sodium-glucose co-transporter-2 inhibitors have demonstrated significant effects in HF with preserved ejection fraction (HFpEF). Left atrium decompression devices (LADd) have been recently investigated as a new interventional approach in patients with HFpEF.
OBJECTIVES
To assess the efficacy of LADd on soft endpoints in HF patients across the spectrum of ejection fraction.
METHODS
PubMed and Web of Science were searched without restrictions from inception to 28 May 2022 to identify valuable articles. The studies that met the inclusion criteria were analyzed. The prespecified main outcomes were the change from baseline in 6-min walking distance (6MWD), NYHA class and health-related quality of life (HRQoL). Secondary outcomes were reduction in HF hospitalizations, echocardiographic, and hemodynamic parameters.
RESULTS
Eleven studies, with a total of 547 patients, were included. LADd significantly improved 6MWD by 43.95 m (95% CI 29.64-58.26 m), decreased NYHA class by 0.93 (95% CI 1.20-0.67), and improved HRQoL questionnaire by 20.45 points (95% CI 13.77-27.14) with better results for all outcomes in patients with lower EFs.
CONCLUSION
The present meta-analysis suggests that LADd are favorable in improving 6MWD, NYHA class, and HRQoL in HF across a wide spectrum of ejection fraction, with better outcomes in patients with lower EFs.
TRIAL REGISTRATION
CRD42022336077, URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336077 .
Topics: Humans; Heart Failure; Stroke Volume; Quality of Life; Prognosis; Decompression
PubMed: 37162633
DOI: 10.1007/s10741-023-10317-2 -
ESC Heart Failure Oct 2022Exercise right heart catheterization (RHC) is considered the gold-standard test to diagnose heart failure with preserved ejection fraction (HFpEF). However, exercise RHC... (Meta-Analysis)
Meta-Analysis
AIMS
Exercise right heart catheterization (RHC) is considered the gold-standard test to diagnose heart failure with preserved ejection fraction (HFpEF). However, exercise RHC is an insufficiently standardized technique, and current haemodynamic thresholds to define HFpEF are not universally accepted. We sought to describe the exercise haemodynamics profile of HFpEF cohorts reported in literature, as compared with control subjects.
METHODS AND RESULTS
We performed a systematic literature review until December 2020. Studies reporting pulmonary artery wedge pressure (PAWP) at rest and peak exercise were extracted. Summary estimates of all haemodynamic variables were evaluated, stratified according to body position (supine/upright exercise). The PAWP/cardiac output (CO) slope during exercise was extrapolated. Twenty-seven studies were identified, providing data for 2180 HFpEF patients and 682 controls. At peak exercise, patients with HFpEF achieved higher PAWP (30 [29-31] vs. 16 [15-17] mmHg, P < 0.001) and mean right atrial pressure (P < 0.001) than controls. These differences persisted after adjustment for age, sex, body mass index, and body position. However, peak PAWP values were highly heterogeneous among the cohorts (I = 93%), with a relative overlap with controls. PAWP/CO slope was steeper in HFpEF than in controls (3.75 [3.20-4.28] vs. 0.95 [0.30-1.59] mmHg/L/min, P value < 0.0001), even after adjustment for covariates (P = 0.007).
CONCLUSIONS
Despite methodological heterogeneity, as well as heterogeneity of pooled haemodynamic estimates, the exercise haemodynamic profile of HFpEF patients is consistent across studies and characterized by a steep PAWP rise during exercise. More standardization of exercise haemodynamics may be advisable for a wider application in clinical practice.
Topics: Humans; Heart Failure; Stroke Volume; Hemodynamics; Pulmonary Wedge Pressure; Exercise Tolerance
PubMed: 35748109
DOI: 10.1002/ehf2.13979 -
European Journal of Heart Failure Feb 2007To summarize and quantify results of echocardiographic studies examining the effect of angiotensin converting enzyme (ACE) inhibition on left ventricular remodelling in... (Meta-Analysis)
Meta-Analysis Review
A systematic review: effect of angiotensin converting enzyme inhibition on left ventricular volumes and ejection fraction in patients with a myocardial infarction and in patients with left ventricular dysfunction.
BACKGROUND AND AIM
To summarize and quantify results of echocardiographic studies examining the effect of angiotensin converting enzyme (ACE) inhibition on left ventricular remodelling in patients with acute myocardial infarction (MI) and in patients with left ventricular systolic dysfunction (LVSD).
METHODS
Systematic review of the literature and meta-analysis of eligible studies providing data on end-diastolic and end-systolic volumes and left ventricular ejection fraction (LVEF) were performed.
RESULTS
Data from 16 eligible studies were meta-analysed. The results of studies including patients with MI and preserved LVEF (>45%) showed no significant benefit of ACE inhibition. Results of studies/subgroups with mean LVEF < or =45% demonstrated significant differences in diastolic and systolic volumes of 3.0 (0.1, 6.0) ml and 2.25 (0.04, 4.4) ml in short-term (4-14 weeks) follow-up in favour of ACE inhibitor, p=0.041 and p=0.046 respectively. In the long-term (6-12 months) follow-up, the differences in diastolic and systolic volumes were 4.2 (0.98, 7.4) ml and 3.3 (0.9, 5.8) ml in favour of ACE inhibitor, p=0.01 and p=0.007 respectively. LVEF improved in both short and long-term follow-up, p=0.034 and p=0.021, respectively.
CONCLUSION
Chronic use of ACE inhibition has a small but sustained and beneficial effect on remodelling in patients with myocardial infarction and patients with chronic left ventricular dysfunction.
Topics: Angiotensin-Converting Enzyme Inhibitors; Chronic Disease; Diastole; Heart Ventricles; Humans; Myocardial Infarction; Randomized Controlled Trials as Topic; Stroke Volume; Systole; Treatment Outcome; Ultrasonography; Ventricular Dysfunction, Left; Ventricular Remodeling
PubMed: 16829187
DOI: 10.1016/j.ejheart.2006.05.002 -
Journal of Cardiac Failure Mar 2010Although renin-angiotensin system (RAS) inhibitors have little demonstrable effect on mortality in patients with heart failure and preserved ejection fraction (HF-PEF),... (Meta-Analysis)
Meta-Analysis Review
The effect of renin-angiotensin system inhibitors on mortality and heart failure hospitalization in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis.
BACKGROUND
Although renin-angiotensin system (RAS) inhibitors have little demonstrable effect on mortality in patients with heart failure and preserved ejection fraction (HF-PEF), some trials have suggested a benefit with regard to reduction in HF hospitalization.
METHODS AND RESULTS
Here, we systematically review and evaluate prospective clinical studies of RAS inhibitors enrolling patients with HF-PEF, including the 3 major trials of RAS inhibition (Candesartan in Patients with Chronic Heart Failure and Preserved Left Ventricular Ejection Fraction [CHARM-Preserved], Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction [I-PRESERVE], and Perindopril in Elderly People with Chronic Heart Failure [PEP-CHF]). We also conducted a pooled analysis of 8021 patients in the 3 major randomized trials of RAS inhibition in HF-PEF (CHARM-Preserved, I-PRESERVE, and PEP-CHF) in fixed-effect models, finding no clear benefit with regard to all-cause mortality (odds ratio [OR] 1.03, 95% confidence interval [CI], 0.92-1.15; P=.62), or HF hospitalization (OR 0.90, 95% CI 0.80-1.02; P=.09).
CONCLUSIONS
Although RAS inhibition may be valuable in the management of comorbidities related to HF-PEF, RAS inhibition in HF-PEF is not associated with consistent reduction in HF hospitalization or mortality in this emerging cohort.
Topics: Age Factors; Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers; Benzimidazoles; Biphenyl Compounds; Female; Heart Failure; Hospital Mortality; Hospitalization; Humans; Irbesartan; Male; Middle Aged; Prognosis; Randomized Controlled Trials as Topic; Renin-Angiotensin System; Risk Factors; Sex Factors; Stroke Volume; Survival Analysis; Tetrazoles; Treatment Outcome
PubMed: 20206902
DOI: 10.1016/j.cardfail.2009.11.007 -
Phlebology Oct 2021To assess the clinical efficacy of sulodexide, including a comparison with venoactive drugs (VAD) (micronized purified flavonoid fraction, MPFF; hydroxy-ethyl-rutosides,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the clinical efficacy of sulodexide, including a comparison with venoactive drugs (VAD) (micronized purified flavonoid fraction, MPFF; hydroxy-ethyl-rutosides, HR; calcium dobesilate;Ruscus extract combined with hesperidin methyl chalcone and vitamin C, Ruscus+HMC+VitC; horse chestnut seed extract, HCSE) and pentoxifylline in patients with chronic venous disease.
METHODS
We performed a literature search in MEDLINE, Embase, and Cochrane Library for randomized controlled trials (RCTs) and observational studies. Proportion of patients with complete venous ulcer healing was the primary outcome and lower leg volume, foot volume, ankle circumference and symptoms were the secondary outcomes. Bayesian network meta-analysis (NMA) was perfomed with random effects models using only RCTs. A meta-analysis of observational studies was performed for sulodexide because no RCT could be included in NMA for symptoms or signs.
RESULTS
Forty-five RCTs and eighteen observational studies were identified. Sulodexide was included only in a single NMA for the proportion of patients with complete ulcer healing and it showed to have the highest probability of being the best treatment (48%) compared with pentoxifylline (37%) and MPFF (16%). MPFF was the most effective treatment in reducing lower leg volume, CIVIQ-20 score and pain VAS scale while calcium dobesilate and Ruscus+HMC+VitC were the most effective in reducing foot volume and ankle circumference respectively.Meta-analyses of observational studies for sulodexide showed that it improves significantly the scoring of pain, feeling of swelling, heaviness and parasthesiae measured by Likert scales.
CONCLUSIONS
Sulodexide is at least as effective as pentoxifylline and more effective than MPFF in improving the rate of ulcer healing in patients with CVD. VADs are effective in improving venous symptoms and signs, as was also shown by sulodexide in the meta-analysis of observational studies. The relative effectiveness of sulodexide and VADs needs to be evaluated by an RCT in order to better inform clinical practice.
Topics: Glycosaminoglycans; Humans; Network Meta-Analysis; Pharmaceutical Preparations; Varicose Ulcer; Vascular Diseases
PubMed: 33983078
DOI: 10.1177/02683555211015020 -
International Journal of Cardiology.... Apr 2024Cardiac magnetic resonance imaging (CMR) based T1 mapping and extracellular volume fraction (ECV) are powerful tools for identifying myocardial fibrosis. This systematic...
BACKGROUND
Cardiac magnetic resonance imaging (CMR) based T1 mapping and extracellular volume fraction (ECV) are powerful tools for identifying myocardial fibrosis. This systematic review and -analysis aims to characterize the utility of native T1 mapping and ECV in patients with non-ischemic cardiomyopathy (NICM) and to clarify the prognostic significance of elevated values.
METHODS
A literature search was conducted for studies reporting on use of CMR-based native T1 mapping and ECV measurement in NICM patients and their association with major adverse cardiac events (MACE), ventricular arrhythmias (VAs), and left ventricular reverse remodeling (LVRR). Databases searched included: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.
RESULTS
Native T1 and ECV were significantly higher in NICM patients compared to controls (MD 78.80, 95 % CI 50.00, 107.59; p < 0.01; MD 5.86, 95 % CI 4.55, 7.16; p < 0.01). NICM patients who experienced MACE had higher native T1 and ECV (MD 52.87, 95 % CI 26.59, 79.15; p < 0.01; MD 6.03, 95 % CI 3.79, 8.26; p < 0.01). There was a non-statistically significant trend toward higher native T1 time in NICM patients who experienced VAs. NICM patients who were poor treatment responders had higher baseline native T1 and ECV (MD 40.58, 95 % CI 12.90, 68.25; p < 0.01; MD 3.29, 95 % CI 2.25, 4.33; p < 0.01).
CONCLUSIONS
CMR-based native T1 and ECV quantification may be useful tools for risk stratification of patients with NICM. They may provide additional diagnostic utility in combination with LGE, which poorly characterizes fibrosis in patients with diffuse myocardial involvement.
PubMed: 38371310
DOI: 10.1016/j.ijcha.2024.101339