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Current Problems in Cardiology Apr 2024Heart failure with preserved ejection fraction (HFpEF) represents a prevalent and increasingly common condition. Recognized for its high incidence, there is a growing... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Heart failure with preserved ejection fraction (HFpEF) represents a prevalent and increasingly common condition. Recognized for its high incidence, there is a growing interest in exploring effective interventions, with exercise emerging as a critical component in the rehabilitation of HFpEF patients. We aim to update evidence on the impact of supervised exercise training on exercise capacity, diastolic function, arterial stiffness, and health-related quality of life (QoL) of individuals diagnosed with HFpEF.
METHODS
We systematically reviewed the literature, searching from inception to December 2023, utilizing databases such as MEDLINE (via PubMed), Google Scholar, the Cochrane Library, ClinicalTrials.gov, and the ScienceDirect portal. Statistical analyses utilized RevMan 5.4 with a random-effects model. Outcomes were presented as the weighted mean difference (WMD) alongside corresponding 95 % confidence intervals (CI), and heterogeneity was assessed using the I test.
RESULTS
Our final analysis included 7 randomized controlled trials (RCTs) of 346 participants, with an exercise follow-up duration of 12 to 48 weeks. In our pooled analysis, diastolic function, measured by E/A (WMD 0.01, 95 % CI: -0.04 to 0.05, p = 0.79; I = 0 %) and E/e' (WMD 0.87, 95 % CI: -11.09 to 12.83, p = 0.89; I = 69 %), showed no significant change post-exercise training. However, exercise capacity, measured by peak V̇o2 significantly improved (WMD 2.57, 95 % CI: 1.38 to 3.75, p < 0.0001; I= 14 %). The QoL assessed by the Minnesota Living with Heart Failure (MLWHF) score remained unchanged (WMD -3.12, 95 % CI: -8.73 to 2.50, p = 0.28; I = 0 %), but the SF-36 physical functioning scale indicated significant improvement (WMD 9.84, 95 % CI: 2.94 to 16.73, p < 0.005; I = 0 %). Arterial stiffness and vascular function remained unaffected, as evidenced by arterial elastance (WMD -0.13, 95 % CI: -0.36 to 0.10, p = 0.26; I = 0 %) and total arterial compliance (WMD 0.12, 95 % CI: -0.26 to 0.49, p = 0.54; I = 0 %).
CONCLUSION
Exercise training is safe and significantly enhances exercise capacity and QoL in HFpEF, with no significant impact on diastolic function, arterial stiffness, or vascular function.
Topics: Humans; Randomized Controlled Trials as Topic; Heart Failure; Diastole; Exercise
PubMed: 38311273
DOI: 10.1016/j.cpcardiol.2024.102426 -
Prognostic value of left ventricular systolic function before vascular surgery: a systematic review.ANZ Journal of Surgery May 2024Vascular surgery carries a high risk of post-operative cardiac complications. Recent studies have shown an association between asymptomatic left ventricular systolic...
BACKGROUND
Vascular surgery carries a high risk of post-operative cardiac complications. Recent studies have shown an association between asymptomatic left ventricular systolic dysfunction and increased risk of major adverse cardiovascular events (MACE). This systematic review aims to evaluate the prognostic value of left ventricular function as determined by left ventricular ejection fraction (LVEF) measured by resting echocardiography before vascular surgery.
METHODS
This review conformed to PRISMA and MOOSE guidelines. PubMed, OVID Medline and Cochrane databases were searched from inception to 27 October 2022. Eligible studies assessed vascular surgery patients, with multivariable-adjusted or propensity-matched observational studies measuring LVEF via resting echocardiography and providing risk estimates for outcomes. The primary outcomes measures were all-cause mortality and congestive heart failure at 30 days. Secondary outcome included the composite outcome MACE.
RESULTS
Ten observational studies were included (4872 vascular surgery patients). Studies varied widely in degree of left ventricular systolic dysfunction, symptom status, and outcome reporting, precluding reliable meta-analysis. Available data demonstrated a trend towards increased incidence of all-cause mortality, congestive heart failure and MACE in patients with pre-operative LVEF <50%. Methodological quality of the included studies was found to be of moderate quality according to the Newcastle Ottawa Checklist.
CONCLUSION
The evidence surrounding the prognostic value of LVEF measurement before vascular surgery is currently weak and inconclusive. Larger scale, prospective studies are required to further refine cardiac risk prediction before vascular surgery.
Topics: Humans; Prognosis; Ventricular Function, Left; Ventricular Dysfunction, Left; Vascular Surgical Procedures; Postoperative Complications; Stroke Volume; Echocardiography; Heart Failure; Systole
PubMed: 38305060
DOI: 10.1111/ans.18866 -
Current Problems in Cardiology Apr 2024Rising incidence of heart failure (HF) in the Western world despite advanced clinical care necessitate exploration of further preventive tools and strategies.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Rising incidence of heart failure (HF) in the Western world despite advanced clinical care necessitate exploration of further preventive tools and strategies. Lipoprotein(a) [Lp(a)], recognized as one of the major cardiovascular risk factors has also been implicated as a risk factor for HF. However, existing evidence remains inconclusive and that has led us to perform this meta-analysis.
METHODS
PubMed/Medline, EMBASE and Scopus were systematically searched for studies evaluating an association of Lp(a) with occurrence of HF from inception-till November 2023. Random effects models and I statistics were used for pooled odds ratio (OR) and heterogeneity assessment. We performed leave one out sensitivity analyses by sequentially removing one study at a time and recalculating the pooled effect size.
RESULT
Our search rendered in total 360 studies and after final screening this resulted in 7 Mendelian randomization (MR) design. According to the MR analysis, increasing Lp(a) level were significantly associated with increased risk of HF (OR 1.064, 95 % CI: 1.043-1.086, I= 97.59 %, P < 0.001). In addition, Leave-one-out sensitivity analysis showed that the effect size did not change substantially by removal of any particular study in MR studies and ORs ranged from 1.051 (when excluding Levin) to a maximum of 1.111 (when excluding Wang or Jiang), hereby confirming the association.
CONCLUSION
We were able to show that by meta-analysis of MR data, increasing lipoprotein (a) levels are associated with an increased risk of HF. Whether this is due to a direct effect on heart muscle contraction or whether this is due to an increased risk of ischemic cardiac disease remains to be elucidated.
Topics: Humans; Coronary Artery Disease; Heart Disease Risk Factors; Heart Failure; Lipoprotein(a); Mendelian Randomization Analysis
PubMed: 38301917
DOI: 10.1016/j.cpcardiol.2024.102439 -
PloS One 2024Treatment of nerve injuries proves to be a worldwide clinical challenge. Acellular nerve allografts are suggested to be a promising alternative for bridging a nerve gap... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Treatment of nerve injuries proves to be a worldwide clinical challenge. Acellular nerve allografts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous nerve graft.
OBJECTIVE
To systematically review the efficacy of the acellular nerve allograft, its difference from the gold standard (the nerve autograft) and to discuss its possible indications.
MATERIAL AND METHODS
PubMed, Embase and Web of Science were systematically searched until the 4th of January 2022. Original peer reviewed paper that presented 1) distinctive data; 2) a clear comparison between not immunologically processed acellular allografts and autologous nerve transfers; 3) was performed in laboratory animals of all species and sex. Meta analyses and subgroup analyses (for graft length and species) were conducted for muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count diameter, tetanic contraction and amplitude using a Random effects model. Subgroup analyses were conducted on graft length and species.
RESULTS
Fifty articles were included in this review and all were included in the meta-analyses. An acellular allograft resulted in a significantly lower muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count and smaller diameter, tetanic contraction compared to an autologous nerve graft. No difference was found in amplitude between acellular allografts and autologous nerve transfers. Post hoc subgroup analyses of graft length showed a significant reduced muscle weight in long grafts versus small and medium length grafts. All included studies showed a large variance in methodological design.
CONCLUSION
Our review shows that the included studies, investigating the use of acellular allografts, showed a large variance in methodological design and are as a consequence difficult to compare. Nevertheless, our results indicate that treating a nerve gap with an allograft results in an inferior nerve recovery compared to an autograft in seven out of eight outcomes assessed in experimental animals. In addition, based on our preliminary post hoc subgroup analyses we suggest that when an allograft is being used an allograft in short and medium (0-1cm, > 1-2cm) nerve gaps is preferred over an allograft in long (> 2cm) nerve gaps.
Topics: Animals; Autografts; Allografts; Nerve Regeneration; Transplantation, Homologous; Transplantation, Autologous; Sciatic Nerve
PubMed: 38295088
DOI: 10.1371/journal.pone.0279324 -
Journal of Functional Morphology and... Jan 2024Kinetic chains (KCs) are primarily affected by the load of different activities that recruit muscles from different regions. We explored the effects of strengthening... (Review)
Review
Kinetic chains (KCs) are primarily affected by the load of different activities that recruit muscles from different regions. We explored the effects of strengthening exercises on KCs through muscle activation. Four databases were searched from 1990 to 2019. The muscles of each KC, their surface electromyography (sEMG), and the exercises conducted were reported. We found 36 studies that presented muscle activation using the percent (%) maximal voluntary isometric contraction (MVIC) or average sEMG for nine KCs in different regions. The % MVIC is presented as the following four categories: low (≤20%), moderate (21~40%), high (41~60%), and very high (>60%). Only four studies mentioned muscle activation in more than three KCs, while the remaining studies reported inconsistent sEMG processing, lacked normalization, and muscle activation in one or two KCs. The roles of stabilizers and the base of support in overhead throwing mobility using balance exercises were examined, and the concentric phase of chin-up and lat pull-down activated the entire KC by recruiting multiple muscles. Also, deep-water running was shown to prevent the risk of falls and enhance balance and stability. In addition, low-load trunk rotations improved the muscles of the back and external oblique activation. Based on this study's findings, closed-chain exercises activate more groups of muscles in a kinetic chain than open-chain exercises. However, no closed or open chain exercise can activate optimal KCs.
PubMed: 38249099
DOI: 10.3390/jfmk9010022 -
Journal of Pediatric Urology Apr 2024Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding.... (Review)
Review
INTRODUCTION
Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding. This contraction causes high post-void residuals (PVR), urinary incontinence and urinary tract infections (UTIs). Various treatments for DV are available, but some children do not respond. Intersphincteric botulinum toxin-A (BTX-A) may be a possible treatment for therapy-refractory children with DV.
OBJECTIVE
The aim of this systematic review is to summarize the effects and safety of intersphincteric BTX-A as a treatment for therapy-refractory DV in children.
METHODS
A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies reporting on the usage of intersphincteric BTX-A as a treatment for DV in children were included. Data on PVR, maximum flow rate (Qmax), repeat injections and complications were extracted.
RESULTS
From a total of 277 articles, five cohort studies were identified, reporting on 78 children with DV of whom 53 were female (68 %) and 25 were male (32 %). Sample sizes ranged from ten to twenty patients. Mean or median age at the time of intervention ranged from 8 to 10.5 years. Meta-analysis could not be performed due to lack of data. The narrative synthesis approach was therefore used to summarize the results. All studies showed significant decrease in PVR after BTX-A injection. Three studies showed a 33-69 % improvement on incontinence after BTX-A injection. Less UTIs were reported after treatment. A temporary increase in incontinence, UTIs and transitory numbness to the gluteus muscle were reported as side-effects.
CONCLUSIONS
BTX-A could be a safe and effective treatment option for therapy-refractory DV in children by reducing PVR, UTIs and incontinence. Hereby, the synergistic effect of BTX-A and urotherapy should be emphasized in future management. Furthermore, this study identified gaps in current knowledge that are of interest for future research.
Topics: Child; Humans; Male; Female; Botulinum Toxins, Type A; Urinary Bladder Diseases; Urinary Incontinence; Urination Disorders; Urethra; Treatment Outcome
PubMed: 38135586
DOI: 10.1016/j.jpurol.2023.10.034 -
The Physician and Sportsmedicine Dec 2023To review the effectiveness of isokinetic training as an alternative method to traditional isotonic resistance training. (Review)
Review
PURPOSE
To review the effectiveness of isokinetic training as an alternative method to traditional isotonic resistance training.
MATERIALS AND METHODS
Researchers examined data from PubMed, CENTRAL, MEDLINE COMPLETE, and Web of Science until February 2023. A total of 365 entries were obtained from databases, including studies that analyzed the effects of isokinetic vs. isotonic-based rehabilitation in athletes (16-50 years) after a surgical knee intervention. Return to sport (RTS), strength of the flex/extensor compartment of the thigh, muscle mass of the thigh, and knee function were screened as main outcomes. Two reviewers independently screened the studies for eligibility and assessed the risk of bias of the included ones.
RESULTS
Six studies involving 181 athletes were included. Isokinetic training demonstrated significant benefits in peak torque for knee flexor-extensor muscles in four studies. Two studies favored isokinetic training over isotonic for strength. Muscle mass findings were mixed, with one study favoring isokinetic significantly and two showing no significant differences. In terms of returning to sport, the isotonic group displayed slightly better limb symmetry index values, but without significance. Isokinetic training outperformed isotonic in two functionality questionnaire studies, while two others showed no significant differences.
CONCLUSIONS
Isokinetic training appears equally, if not more effective than isotonic, for restoring strength balance between hamstrings and quadriceps. This could lead to more favorable muscle mass changes. Isokinetic training also parallels isotonic rehabilitation for functional outcomes and meeting return-to-sport criteria. Therefore, isokinetic training should be included as one of the main strength restoration strategies after knee surgery, especially in early and middle rehabilitation stages.
REGISTRATION NUMBER
The present systematic review was registered on PROSPERO (registration number: CRD42022370398).
PubMed: 38124233
DOI: 10.1080/00913847.2023.2297666 -
Frontiers in Physiology 2023Fatty acid translocase (FAT/CD36) is a transmembrane glycoprotein belonging to the scavenger class B receptor family and is encoded by the cluster of differentiation 36...
Fatty acid translocase (FAT/CD36) is a transmembrane glycoprotein belonging to the scavenger class B receptor family and is encoded by the cluster of differentiation 36 (CD36) gene. This receptor has a high affinity for fatty acids and is involved in lipid metabolism. An abundance of FAT/CD36 during exercise occurs in mitochondria and solitary muscles. As such, we aimed to systematically review the evidence for the relationship FAT/CD36 and adipose tissue lipolysis during exercise training. Five electronic databases were selected for literature searches until June 2022: PubMed, Web of Science, Scopus, science direct, and Google Scholar. We combined the different synonyms and used the operators ("AND", "OR", "NOT"): (CD36 gene) OR (CD36 polymorphism) OR (cluster of differentiation 36) OR (FAT/CD36) OR (fatty acid translocase) OR (platelet glycoprotein IV) OR (platelet glycoprotein IIIb) AND (adipose tissue lipolysis) OR (fatty acids) OR (metabolism lipid) OR (adipocytes) AND (physical effort) OR (endurance exercise) OR (high-intensity training). All published cross-sectional, cohort, case-control, and randomized clinical trials investigating CD36 polymorphisms and adipose tissue lipolysis during exercise in subjects (elite and sub-elite athletes, non-athletes, sedentary individuals and diabetics), and using valid methods to measure FAT/CD36 expression and other biomarkers, were considered for inclusion in this review. We initially identified 476 publications according to the inclusion and exclusion criteria, and included 21 studies investigating FAT/CD36 and adipose tissue lipolysis during exercise in our systematic review after examination of titles, abstracts, full texts, and quality assessments using the PEDro scale. There were nine studies with male-only participants, three with female-only participants, and nine studies included both female and male participants. There were 859 participants in the 21 selected studies. Studies were classified as either low quality ( = 3), medium quality ( = 13), and high quality ( = 5). In general, the data suggests an association between FAT/CD36 and adipose tissue lipolysis during exercise training. Improvements in FAT/CD36 were reported during or after exercise in 6 studies, while there were no changes reported in FAT/CD36 in 4 studies. An association between fat oxidation and FAT/CD36 expression during exercise was reported in 7 studies. No agreement was reached in 5 studies on FAT/CD36 content after dietary changes and physical interventions. One study reported that FAT/CD36 protein expression in muscle was higher in women than in men, another reported that training decreased FAT/CD36 protein in insulin-resistant participants, while another study reported no differences in FAT/CD36 in young, trained individuals with type 2 diabetes. Our analysis shows an association between FAT/CD36 expression and exercise. Furthermore, an association between whole-body peak fat oxidation and FAT/CD36 expression during exercise training was demonstrated. Systematic Review Registration: [PROSPERO], identifier [CRD42022342455].
PubMed: 38074329
DOI: 10.3389/fphys.2023.1256440 -
Frontiers in Medicine 2023This systematic literature review and meta-analysis aimed to determine the effect of body position on the measurement of pelvic floor muscle (PFM) contractility and to...
OBJECTIVES
This systematic literature review and meta-analysis aimed to determine the effect of body position on the measurement of pelvic floor muscle (PFM) contractility and to analyze the influential factors.
DATA SOURCES
Five databases (PubMed, Web of Science, EMBASE, Cochrane Library and Scopus) were searched for relevant studies published up to 12nd October 2023.
STUDY SELECTION OR ELIGIBILITY CRITERIA
Included cross-sectional studies had to involve the assessment of pelvic floor muscle function in at least two positions.
STUDY APPRAISAL AND SYNTHESIS METHODS
We calculated standardized mean difference (SMD) with 95% confidence intervals (CI) to ascertain the potential effect of body position on outcomes.
RESULTS
In total, we included 11 cross-sectional studies to ascertain the potential effect of body position on outcomes. There was no statistical difference in the results of maximum voluntary contraction (MVC) of the pelvic floor muscles when assessed in between supine and standing positions (SMD -0.22; 95% CI -0.72 to 0.28; = 0.38). The results of the meta-analysis showed significantly larger values of resting voluntary contractions (RVC) measured in the standing position compared to the supine position (SMD -1.76; 95% CI -2.55 to -0.97; < 0.001). Moreover, pelvic floor muscle movement during pelvic floor muscle contraction in the standing position was significantly better than that measured in the supine position (SMD -0.47; 95% CI -0.73 to 0.20; < 0.001).
CONCLUSION
The results of this study showed that the RVC and PFM movement varied with the position of the assessment. In contrast, MVC values are independent of the assessment position and can be selected according to clinical needs.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42022363734, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022363734.
PubMed: 38020153
DOI: 10.3389/fmed.2023.1252779 -
Journal of Strength and Conditioning... Dec 2023Doma, K, Matoso, B, Protzen, G, Singh, U, and Boullosa, D. The repeated bout effect of multiarticular exercises on muscle damage markers and physical performances: a... (Meta-Analysis)
Meta-Analysis
Doma, K, Matoso, B, Protzen, G, Singh, U, and Boullosa, D. The repeated bout effect of multiarticular exercises on muscle damage markers and physical performances: a systematic review and meta-analyses. J Strength Cond Res 37(12): 2504-2515, 2023-This systematic review and meta-analysis compared muscle damage markers and physical performance measures between 2 bouts of multiarticular exercises and determined whether intensity and volume of muscle-damaging exercises affected the outcomes. The eligibility criteria consisted of (a) healthy male and female adults; (b) multiarticular exercises to cause muscle damage across 2 bouts; (c) outcome measures were compared at 24-48 hours after the first and second bouts of muscle-damaging exercise; (d) at least one of the following outcome measures: creatine kinase (CK), delayed onset of muscle soreness (DOMS), muscle strength, and running economy. Study appraisal was conducted using the Kmet tool, whereas forest plots were derived to calculate standardized mean differences (SMDs) and statistical significance and alpha set a 0.05. After screening, 20 studies were included. The levels of DOMS and CK were significantly greater during the first bout when compared with the second bout at T24 and T48 (p < 0.001; SMD = 0.51-1.23). Muscular strength and vertical jump performance were significantly lower during the first bout compared with the second bout at T24 and T48 (p ≤ 0.05; SMD = -0.27 to -0.40), whereas oxygen consumption and rating of perceived exertion were significantly greater during the first bout at T24 and T48 (p < 0.05; SMD = 0.28-0.65) during running economy protocols. The meta-analyses were unaffected by changes in intensity and volume of muscle-damaging exercises between bouts. Multiarticular exercises exhibited a repeated bout effect, suggesting that a single bout of commonly performed exercises involving eccentric contractions may provide protection against exercise-induced muscle damage for subsequent bouts.
Topics: Adult; Humans; Male; Female; Muscle, Skeletal; Exercise; Myalgia; Running; Creatine Kinase; Physical Functional Performance; Muscle Contraction
PubMed: 38015738
DOI: 10.1519/JSC.0000000000004628