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The Clinical Respiratory Journal Apr 2022We conducted a meta-analysis to systematic assess the diagnostic value of computed tomography (CT)-based pulmonary artery to aorta (PA:A) ratio measurement in COPD with... (Meta-Analysis)
Meta-Analysis Review
Diagnostic value of computed tomography-based pulmonary artery to aorta ratio measurement in chronic obstructive pulmonary disease with pulmonary hypertension: A systematic review and meta-analysis.
OBJECTIVE
We conducted a meta-analysis to systematic assess the diagnostic value of computed tomography (CT)-based pulmonary artery to aorta (PA:A) ratio measurement in COPD with pulmonary hypertension (COPD-PH).
METHODS
Published studies referring to diagnostic accuracy of PA:A ratio for COPD-PH were screened out from PubMed, Embase, Web of science, China National Knowledge databases (CNKI), Wan fang databases, and VIP databases. We used bivariate random-effects model to estimate pooled sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR, respectively), and diagnostic odds ratios (DOR). Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were also calculated to summarize the aggregate diagnostic performance.
RESULTS
Nine eligible studies were included and the pooled SEN was 69% (95% CI: 59 ~ 78), SPE was 85% (95% CI: 77 ~ 90), PLR was 4.5 (95% CI: 2.8 ~ 7.5), and NLR was 0.36 (95% CI: 0.26 ~ 0.51), respectively. DOR reached 13.00 (95% CI: 6.00 ~ 28.00), and value of AUC was 0.84 (95% CI: 0.81 ~ 0.87). Subgroup analysis indicated that when the value of PA:A ratio was equal or greater than one (PA/A ≥ 1), the combined SEN, SPE, AUC, and DOR was 69%, 89%, 0.90, and 19.65, respectively.
CONCLUSIONS
PA:A ratio is helpful for appraisal of COPD-PH, and PA/A ≥ 1 possessed prominent diagnostic accuracy.
Topics: Aorta; Humans; Hypertension, Pulmonary; Pulmonary Artery; Pulmonary Disease, Chronic Obstructive; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 35289083
DOI: 10.1111/crj.13485 -
International Journal of Surgery... Mar 2023Because of relatively little data for management and evaluation surrounding spontaneous isolated visceral artery dissection (IVAD), existing studies have failed to... (Meta-Analysis)
Meta-Analysis
Comparative analysis of prevalence, evaluation, management, and rehabilitation outcome of spontaneous isolated visceral artery dissection: a systematic review and meta-analysis of 80 reports.
BACKGROUND
Because of relatively little data for management and evaluation surrounding spontaneous isolated visceral artery dissection (IVAD), existing studies have failed to provide comprehensive analysis for the management, evaluation, prevalence, as well as natural course of the disease. Therefore, we collected and analyzed current evidence on spontaneous IVAD with the aim of providing quantitative pooled data for the natural course and treatment standardization of the disease.
METHODS
A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science up to 1 June 2022, was conducted for relevant studies that investigating the natural course, treatment, classification, and outcomes of IVAD. The primary outcomes were to determine the difference in prevalence, risk factors, and characteristics between different spontaneous IVAD. Two reviewers assessed the trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0.
RESULTS
A total of 80 reports with 1040 patients were identified. The pooled results indicated that in IVAD, isolated superior mesenteric artery dissection (ISMAD) was more prevalent, with a pooled prevalence of 60% (95% CI: 50-71%), followed by isolated celiac artery dissection (ICAD) (prevalence: 37%; 95% CI: 27-46%). IVAD was male predominated with a pooled proportion of 80% (95% CI: 72-89%). Similar results were found in ICAD (prevalence: 73%; 95% CI: 52-93%). More IVAD patients were diagnosed with symptoms than ICAD (64 vs. 59%). Regarding to the risk factors, this pooled analysis found smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients, with proportion of 43, 41, 44, and 32%, respectively. It was observed that ICAD appeared shorter dissection length (mean difference: -3.4 cm; 95% CI: -4.9 to -2.0; P <0.0001), higher prevalence of Sakamoto's classification Π (odds ratio: 5.31; 95% CI: 1.77-15.95; P= 0.003) and late progression (odds ratio: 2.84; 95% CI: 1.02-7.87; P= 0.05) than ISAMD.
CONCLUSIONS
Spontaneous IVAD was male predominant and ISMAD was most prevalent followed by ICAD. Smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients. The majority of patients diagnosed with IVAD received observation and conservative treatment and experienced a low proportion of reintervention or progression, especially for ICAD patients. In addition, ICAD and ISMAD had several differences in clinical features and dissection characteristics. Future studies with enough sample size and long follow-up are required to clear the management, long-term outcome, and risk factors of the IVAD prognosis.
Topics: Humans; Male; Prevalence; Treatment Outcome; Prognosis; Aortic Dissection; Hypertension; Arteries
PubMed: 36912770
DOI: 10.1097/JS9.0000000000000301 -
F1000Research 2019This study aims to analyse the efficacy of different treatment methods for acute basilar artery occlusion, with an emphasis placed on evaluating the latest treatment... (Meta-Analysis)
Meta-Analysis
This study aims to analyse the efficacy of different treatment methods for acute basilar artery occlusion, with an emphasis placed on evaluating the latest treatment methods. A systematic review and meta-analysis was performed to analyse the current data on the therapies available for treating acute basilar artery occlusion. A total of 102 articles were included. The weighted pooled rate of mortality was 43.16% (95% CI 38.35-48.03%) in the intravenous thrombolysis group, 45.56% (95% CI 39.88-51.28) in the intra-arterial thrombolysis group, and 31.40% (95% CI 28.31-34.56%) for the endovascular thrombectomy group. The weighted pooled rate of Modified Ranking Score (mRS) 0-2 at 3 months was 31.40 (95% CI 28.31-34.56%) in the IVT group, 28.29% (95% CI 23.16-33.69%) in the IAT group, and 35.22% (95% CI 32.39-38.09%) for the EVT group. Meta-analyses were also done for the secondary outcomes of recanalization and symptomatic haemorrhage. There was no difference between stent retriever and thrombo-aspiration thrombectomy on subgroup analysis in both clinical outcome and safety profile. : The included studies were observational in nature. There was significant heterogeneity in some of the outcomes. Superior outcomes and better recanalization rates for acute basilar occlusion were seen with patients managed with endovascular thrombectomy when compared with either intravenous and/or intraarterial thrombolysis. No superiority of stent-retrievers over thrombo-aspiration thrombectomy was seen.
Topics: Basilar Artery; Humans; Observational Studies as Topic; Stents; Thrombectomy; Thrombosis; Treatment Outcome
PubMed: 31016013
DOI: 10.12688/f1000research.18042.1 -
Journal of Vascular Surgery Jul 2018The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants.
METHODS
A systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed.
RESULTS
A total of 51 articles were included (N = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations.
CONCLUSIONS
Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.
Topics: Aneurysm; Aorta, Thoracic; Black People; Brachiocephalic Trunk; Cardiovascular Abnormalities; Carotid Arteries; Humans; Incidence; Prevalence; Prognosis; Subclavian Artery; Vertebral Artery
PubMed: 28865978
DOI: 10.1016/j.jvs.2017.06.097 -
International Journal of Cardiology Jul 2013Radial artery access is a mainstay in the diagnosis and treatment of coronary artery disease. However, there is uncertainty on the comparison of right versus left radial... (Comparative Study)
Comparative Study Meta-Analysis Review
Right versus left radial artery access for coronary procedures: an international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients.
BACKGROUND
Radial artery access is a mainstay in the diagnosis and treatment of coronary artery disease. However, there is uncertainty on the comparison of right versus left radial access for coronary procedures. We thus undertook a systematic review and meta-analysis comparing right versus left radial access for coronary diagnostic and interventional procedures.
METHODS
Pertinent studies were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus, together with international conference proceedings. Randomized trials comparing right versus left radial (or ulnar) access for coronary diagnostic or interventional procedures were included. Risk ratios (RR) and weighted mean differences (WMD) were computed to generate point estimates (95% confidence intervals).
RESULTS
A total of 5 trials (3210 patients) were included. No overall significant differences were found comparing right versus left radial access in terms of procedural time (WMD=0.99 [-0.53; 2.51]min, p=0.20), contrast use (WMD=1.71 [-1.32; 4.74]mL, p=0.27), fluoroscopy time (WMD=-35.79 [-3.54; 75.12]s, p=0.07) or any major complication (RR=2.00 [0.75; 5.31], p=0.49). However, right radial access was fraught with a significantly higher risk of failure leading to cross-over to femoral access (RR=1.65 [1.18; 2.30], p=0.003) in comparison to left radial access.
CONCLUSIONS
Right and left radial accesses appear largely similar in their overall procedural and clinical performance during transradial diagnostic or interventional procedures. Nonetheless, left radial access can be recommended especially during the learning curve phase to reduce femoral cross-overs.
Topics: Cooperative Behavior; Coronary Artery Disease; Humans; Internationality; Percutaneous Coronary Intervention; Radial Artery; Randomized Controlled Trials as Topic
PubMed: 22192284
DOI: 10.1016/j.ijcard.2011.11.100 -
European Journal of Vascular and... May 2022Kidney autotransplantation (ATx) is a treatment option for distal renal artery aneurysm (RAA). This systematic review evaluated the indications, treatment strategy, and... (Review)
Review
OBJECTIVE
Kidney autotransplantation (ATx) is a treatment option for distal renal artery aneurysm (RAA). This systematic review evaluated the indications, treatment strategy, and outcome of kidney ATx to verify the value of this procedure in treating RAA.
DATA SOURCES
PubMed, Embase, and Web of Science.
REVIEW METHODS
All study types were included, except study protocols and animal studies, without time or language restrictions. Data sources were reviewed until April 2021 to identify relevant articles evaluating operating time, cold and warm ischaemia time, total complications, length of hospital stay, and mortality rate in patients with RAA receiving kidney ATx.
RESULTS
The literature search retrieved 644 articles. Of these, 55 clinical studies (including 37 case reports and 18 case series) investigating 199 patients were eligible for inclusion. Endovascular treatment had failed in 17% of 70 patients with RAA. Heterotopic kidney ATx was performed in 81% of patients, and 19% received orthotopic kidney ATx. Unplanned nephrectomy was reported in only one patient (0.1%). Post-operative complications were reported in 6.9% of patients, including urinary tract infection (2.0%), wound infection (1.3%), acute renal insufficiency (0.6%), graft thrombosis (0.6%), kidney hypoperfusion (0.6%), haematoma (0.6%), lymphocoele (0.6%), pseudoaneurysm (0.6%), and arterial occlusion (0.6%). None of the patients died peri-operatively, and organ loss was reported in only one patient (0.05%). No further organ loss or death was reported during follow up (median follow up duration 12 months).
CONCLUSION
In patients with distal perihilar RAA, surgical repair with kidney ATx appears to be a suitable alternative when endovascular approaches are not appropriate. In these cases, kidney ATx saves the kidney and provides good clinical outcomes. However, these findings should be interpreted with caution, considering the lack of data regarding the adverse events, potential for favourable publication bias among included studies, and the absence of consecutive series and prospective trials.
Topics: Aneurysm; Humans; Kidney; Kidney Diseases; Prospective Studies; Renal Artery; Retrospective Studies; Transplantation, Autologous; Treatment Outcome
PubMed: 35283006
DOI: 10.1016/j.ejvs.2022.01.015 -
Vascular Dec 2023This study aims to assess prevalence and prognostic implications of pre-existing peripheral artery disease (PAD) in patients infected by the SARS-CoV-2 by means of a... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
This study aims to assess prevalence and prognostic implications of pre-existing peripheral artery disease (PAD) in patients infected by the SARS-CoV-2 by means of a systematic review and meta-analysis.
MATERIAL AND METHODS
We searched MEDLINE and Scopus to locate all the articles published up to 10 December 2021, reporting data on pre-existing PAD among COVID-19 survivors (S) and non survivors (NS). The pooled prevalence of pre-existing PAD in COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I statistic.
RESULTS
Eight investigations, enrolling 13,776 COVID-19 patients (mean age: 67.1 years, 3.863 males), met the inclusion criteria and were included in the final analysis. The pooled prevalence of pre-existing PAD was 5.7% of cases (95% CI: 3.8-8.4%, < 0.0001), with high heterogeneity (I = 84.5%), which was directly correlated with age ( < 0.0001), previous hypertension ( = 0.003), and dyslipidaemia ( = 0.02) as demonstrated by the meta-regression. Moreover, pre-existing PAD was significantly associated with higher risk of short-term death in patients with SARS-CoV-2 infection (OR: 2.78, 95% CI: 2.37-3.27, < 0.0001 I = 0%); the sensitivity analysis confirmed yielded results.
CONCLUSIONS
Pre-existing PAD represents a comorbidity in about 1 out of 6 COVID-19 patients, but it is associated with a twofold higher risk of short-term mortality.
Topics: Male; Humans; Aged; Prevalence; COVID-19; SARS-CoV-2; Peripheral Arterial Disease; Arteries
PubMed: 35593210
DOI: 10.1177/17085381221100380 -
Medicine May 2018Coronary artery calcificition (CAC) is a well-established predictor of cardiovascular events (CVEs). We aimed to evaluate whether lung cancer screening computed... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Coronary artery calcificition (CAC) is a well-established predictor of cardiovascular events (CVEs). We aimed to evaluate whether lung cancer screening computed tomography (CT)-based CAC score has a good cost-effectiveness for predicting CVEs in heavy smokers.
METHODS
A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, EMBASE, and Cochrane library databases were systematically searched for relevant studies that investigated the association between lung cancer screening CT-based CAC and CVEs up to December 31, 2017. We selected fixed-effect model for analysis of data heterogeneity. Statistical analyses were performed by using Review Manager Version 5.3 for Windows.
RESULTS
Four randomized controlled trials with 5504 participants were included. Our results demonstrated that CVEs were significantly associated with the presence of CAC (relative risk [RR] 2.85, 95% confidence interval [CI] 2.02-4.02, P < .00001). Moreover, higher CAC score (defined as CAC score >400 or >1000) was associated with a significant increased CVE count (RR 3.47, 95% CI 2.65-4.53, P < .00001). However, the prevalence of CVEs was not different between male and female groups (RR 2.46, 95% CI 0.44-13.66, P = .30).
CONCLUSION
CAC Agatston score evaluated by lung cancer screening CT had potential in predicting the likelihood of CVEs in the early stage without sexual difference. Thus, it may guide clinicians to intervene those heavy smokers with increased risk of CVEs earlier by CAC score through lung cancer screening CT.
Topics: Coronary Artery Disease; Coronary Vessels; Cost-Benefit Analysis; Early Detection of Cancer; Female; Humans; Lung Neoplasms; Male; Middle Aged; Risk Assessment; Tomography, X-Ray Computed; Vascular Calcification
PubMed: 29768322
DOI: 10.1097/MD.0000000000010461 -
The Journal of Maternal-fetal &... Dec 2023Transcervical resection of adhesion (TCRA) and postoperative adjuvant estrogen and progestin are the main treatments for cavity adhesions, but the recurrence rate after... (Meta-Analysis)
Meta-Analysis Review
The effect of aspirin on uterine arterial blood flow and endometrium in moderate and severe intrauterine adhesion after transcervical resection of adhesion: a systematic review and meta-analysis.
BACKGROUND
Transcervical resection of adhesion (TCRA) and postoperative adjuvant estrogen and progestin are the main treatments for cavity adhesions, but the recurrence rate after surgery is still high. It was showed that aspirin could promote endometrial proliferation and repair after TCRA in patients with severe cavity adhesions, but the effect on reproduction was uncertain.
OBJECTIVE
To assess the effect of aspirin on uterine arterial blood flow and endometrium in moderate and severe intrauterine adhesion after transcervical resection of adhesion.
METHODS
The databases used included Cumulative Index to PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), and Wanfang database. Studies published before June 2022 were included. Each participant received an aspirin-based intervention aimed at improving uterine status, which was compared to a sham intervention. The primary outcome measure was a change in endometrium thickness. Secondary outcomes included uterine artery resistance index, blood flow index, and endometrial arterial resistance index.
RESULT
A total of 19 studies ( = 1361 participants) that met the inclusion criteria were included in this study. The aspirin-based intervention was strongly associated with better clinical outcome at second-look endometrium thickness (MD 0.81, CI 0.46-1.16; < .00001) and blood flow Index (FI) (MD 4.1, CI 2.3-5.9; < .00001). Besides, the analysis of arterial pulsatility index (PI) showed a significantly reduced after transcervical resection of adhesion (MD -0.9, CI -1.2 to 0.6; < .00001); whereas no significant difference was found in endometrial arterial resistance index (RI) (95% CI, -0.30 to 0.01; = .07).
CONCLUSION
Our study proved the effect of aspirin on uterine arterial blood flow and endometrium in moderate and severe intrauterine adhesion after transcervical resection of adhesion. However, the review requires evidence from additional randomized controlled trials and high-quality research. More strictly designed research studies are needed to assess the effectiveness of aspirin administration after transcervical resection of adhesion.
Topics: Female; Humans; Aspirin; Uterine Artery; Uterine Diseases; Endometrium; Uterus
PubMed: 37286223
DOI: 10.1080/14767058.2023.2209818 -
The Journal of Thoracic and... May 2017This meta-analysis examines whether there is any advantage of coronary artery bypass graft with bilateral internal thoracic artery (BITA) as an in situ versus composite... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This meta-analysis examines whether there is any advantage of coronary artery bypass graft with bilateral internal thoracic artery (BITA) as an in situ versus composite graft.
METHODS
We searched MEDLINE and EMBASE Databases from 1996 to 2016 for studies that compared coronary artery bypass graft with BITA as in situ versus composite graft. Data were extracted by 2 independent investigators and meta-analyzed with the use of random effects.
RESULTS
Two randomized controlled trials (RCTs; n = 705), 2 matched (n = 1688), and 4 unadjusted observational studies (n = 3517) met inclusion criteria. Composite grafting trended towards greater distal anastomoses (+0.22, 95% confidence interval, -0.01 to +0.45 anastomoses/patient; P = .06 [4 unadjusted observational studies]) and greater distal anastomoses using an internal thoracic artery (+0.80, 95% confidence interval, 0.41-1.18 anastomoses/patient; P < .001 [1 RCT]). There were no differences in perioperative or longer-term composite cardiovascular outcomes comparing in situ versus composite BITA or individual outcomes of mortality, repeat revascularization, myocardial infarction, and cardiovascular mortality. Pooled results differed by study type with pooled results from lower-risk-of-bias RCTs typically showing increases in events rates, and pooled results from higher-risk-of-bias unadjusted observational studies typically showing decreases in event rates of in situ versus composite BITA. Post hoc subgroup analysis suggested possible improvements in all-cause mortality and revascularization for in situ BITA in studies with short-term (<5 years) versus longer-term follow-up, regardless of study type.
CONCLUSIONS
Our meta-analysis found that use of BITA as a composite graft configuration facilitated greater internal thoracic artery revascularization but both grafting strategies offer similar clinical outcomes. Our study supports the use of in situ and composite BITA for select patients but high-quality, long-term prospective trials are needed.
Topics: Aged; Coronary Artery Bypass; Coronary Artery Disease; Coronary Vessels; Female; Humans; Internal Mammary-Coronary Artery Anastomosis; Male; Middle Aged; Postoperative Complications; Risk Assessment; Risk Factors; Treatment Outcome; Vascular Patency
PubMed: 28017369
DOI: 10.1016/j.jtcvs.2016.11.027