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The Cochrane Database of Systematic... Jan 2005In the treatment of chronic heart failure, vasodilating agents, ACE inhibitors and beta-blockers have shown an increase of life expectancy. Another strategy is to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In the treatment of chronic heart failure, vasodilating agents, ACE inhibitors and beta-blockers have shown an increase of life expectancy. Another strategy is to increase the inotropic state of the myocardium : phosphodiesterase inhibitors (PDIs) act by increasing intra-cellular cyclic AMP, thereby increasing the concentration of intracellular calcium, and lead to a positive inotropic effect.
OBJECTIVES
This overview on summarised data aims to review the data from all randomised controlled trials of PDIs III versus placebo in symptomatic patients with chronic heart failure. The primary endpoint is total mortality. Secondary endpoints are considered such as cause-specific mortality, worsening of heart failure (requiring intervention), myocardial infarction, arrhythmias and vertigos. We also examine whether the therapeutic effect is consistent in the subgroups based on the use of concomitant vasodilators, the severity of heart failure, and the type of PDI derivative and/or molecule. This overview updates our previous meta-analysis published in 1994.
SEARCH STRATEGY
Randomised trials of PDIs versus placebo in heart failure were searched using MEDLINE (1966 to 2004 January), EMBASE (1980 to 2003 December), Cochrane CENTRAL trials (The Cochrane Library Issue 1, 2004) and McMaster CVD trials registries, and through an exhaustive handsearching of international abstracting publications (abstracts published in the last 22 years in the "European Heart Journal", the "Journal of the American College of Cardiology" and "Circulation").
SELECTION CRITERIA
All randomised controlled trials of PDIs versus placebo with a follow-up duration of more than three months.
DATA COLLECTION AND ANALYSIS
21 trials (8408 patients) were eligible for inclusion in the review. 4 specific PDI derivatives and 8 molecules of PDIs have been considered.
MAIN RESULTS
As compared with placebo, treatment with PDIs was found to be associated with a significant 17% increased mortality rate (The relative risk was 1.17 (95% confidence interval 1.06 to 1.30; p<0.001). In addition, PDIs significantly increase cardiac death, sudden death, arrhythmias and vertigos. Considering mortality from all causes, the deleterious effect of PDIs appears homogeneous whatever the concomitant use (or non-use) of vasodilating agents, the severity of heart failure, the derivative or the molecule of PDI used.
AUTHORS' CONCLUSIONS
Our results confirm that PDIs are responsible for an increase in mortality rate compared with placebo in patients suffering from chronic heart failure. Currently available results do not support the hypothesis that the increased mortality rate is due to additional vasodilator treatment. Consequently, the chronic use of PDIs should be avoided in heart failure patients.
Topics: 3',5'-Cyclic-AMP Phosphodiesterases; Administration, Oral; Cyclic Nucleotide Phosphodiesterases, Type 3; Heart Failure; Humans; Phosphodiesterase Inhibitors; Randomized Controlled Trials as Topic
PubMed: 15674893
DOI: 10.1002/14651858.CD002230.pub2 -
Translational Cancer Research May 2022Cancer therapy-related cardiotoxicity has recently become an area of intense research. As the prognostic role of the right ventricle (RV) in a variety of cardiovascular...
BACKGROUND
Cancer therapy-related cardiotoxicity has recently become an area of intense research. As the prognostic role of the right ventricle (RV) in a variety of cardiovascular diseases has been confirmed, and several studies have paid increased attention to RV function in cancer patients who have underwent chemotherapy, we provide a meta-analysis to objectively evaluate the mechanical properties of the right ventricular myocardium by echocardiography in this population.
METHODS
We systematically searched Embase, PubMed, and Cochrane databases were applied to search for studies (published before August 11, 2021) comparing RV contraction measured by echocardiography at baseline to follow-up in cancer patients who underwent chemotherapy or radiotherapy. The mechanical properties of the right ventricular myocardium were pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), systolic velocity of tricuspid annulus (S'), right ventricular free wall longitudinal strain (RVFWLS), right ventricular global longitudinal strain (RVGLS), and right ventricular fractional area change (RVFAC). We analyzed pooled data using a random-effects model and assessed risk of bias in the included studies using the Newcastle-Ottawa Scale.
RESULTS
Twenty-one trials were enrolled (N=1,355 participants). Cancer patients who underwent chemotherapy but not radiotherapy showed an increase in PASP [standardized mean difference (SMD) =0.161, 95% CI: 0.007 to 0.316) compared with the condition at baseline, as well as reductions in TAPSE (SMD =-0.543, 95% CI: -0.698 to -0.389), S' (SMD =-0.507, 95% CI: -0.748 to -0.266), RVFWLS (SMD =0.833, 95% CI: 0.549 to 1.118) and RVGLS (SMD =1.017, 95% CI: 0.751 to 1.283). There was no significant difference in RVFAC (SMD =-0.097, 95% CI: -0.213 to 0.018). Furthermore, these indicators pointed to a deterioration of right ventricular contraction function in cancer patients who underwent chemotherapy and radiotherapy. The risk of bias of the included studies evaluated by the Newcastle-Ottawa Scale was medium to high.
DISCUSSION
Right ventricular contraction function would deteriorate in cancer patients who underwent chemotherapy and radiotherapy, especially with the prolongation of chemotherapy duration and accumulation of chemotherapeutic drugs. Further studies are needed to establish the definition of right ventricular systolic dysfunction in clinical practice.
PubMed: 35706806
DOI: 10.21037/tcr-21-2324 -
Journal of Cardiovascular Magnetic... Dec 2016Myocardial fibrosis is being increasingly recognised as a common final pathway of a wide range of diseases. Thus, the development of an accurate and convenient method to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Myocardial fibrosis is being increasingly recognised as a common final pathway of a wide range of diseases. Thus, the development of an accurate and convenient method to evaluate myocardial fibrosis is of major importance. Although T1 mapping is a potential alternative for myocardial biopsy, validation studies are limited to small numbers and vary regarding technical facets, and include only a restricted number of disease. A systematic review and meta-analysis was conducted to objectively and comprehensively evaluate the performance of T1 mapping on the quantification of myocardial fibrosis using cardiovascular magnetic resonance (CMR).
METHODS
PubMed, EMBASE and the Cochrane Library databases were searched for studies applying T1 mapping to measure myocardial fibrosis and that validated the results via histological analysis. A pooled correlation coefficient between the CMR and histology measurements was used to evaluate the performance of the T1 mapping.
RESULTS
A total of 15 studies, including 308 patients who had CMR and myocardial biopsy were included and the pooled correlation coefficient between ECV measured by T1 mapping and biopsy for the selected studies was 0.884 (95% CI: 0.854, 0.914) and was not notably heterogeneous chi-squared = 7.44; P = 0.489 for the Q test and I^2 = 0.00%).
CONCLUSIONS
The quantitative measurement of myocardial fibrosis via T1 mapping is associated with a favourable overall correlation with the myocardial biopsy measurements. Further studies are required to determine the calibration of the T1 mapping results for the biopsy findings of different cardiomyopathies.
Topics: Biopsy; Chi-Square Distribution; Fibrosis; Heart Diseases; Humans; Magnetic Resonance Imaging; Myocardium; Predictive Value of Tests; Reproducibility of Results
PubMed: 27955698
DOI: 10.1186/s12968-016-0313-7 -
Journal of Cardiothoracic Surgery Jan 2021Cardiac lipoma is an uncommon primary cardiac tumor. With the advancement of diagnostic methods and treatment techniques, more cases of cardiac lipomas have been...
Cardiac lipoma is an uncommon primary cardiac tumor. With the advancement of diagnostic methods and treatment techniques, more cases of cardiac lipomas have been reported and suggest that the entity previously widely thought to display classic features may also show atypical findings. A systemic review of the rare cardiac tumor was done by searching the literature of cardiac lipoma. We endeavor to summarize the clinical features of the rare disease from pathogenesis to treatment. Literature of cardiac lipoma was retrospectively searched through PubMed and 255 cases of cardiac lipoma were included into this analysis. Cardiac lipomas can occur anywhere within the heart, 53.1% were located within the cardiac chambers, 32.5% in the pericardium, 10,7% within the myocardium and 3.7% involved multiple structures. More than half of the reported cardiac lipomas (66%) may be clinically symptomatic, presenting with symptoms ranging from chest discomfort to syncope depending on their size and location as well as extent of myocardial involvement. Noninvasive cardiac imaging has replaced the role of autopsy and cardiothoracic surgery in detection and diagnosis of cardiac lipomas. Most symptomatic patients (83.7%) were treated by resection of cardiac lipomas and 68.3% of asymptomatic patients also underwentprophylactic resection. Overgrowth and myocardial infiltration of lipomas may result in unsuccessful resection. Recurrence of cardiac lipomas was rare but reported in a few cases. The early detection and accurate diagnosis of cardiac lipoma is of great significance in clinical management, to avoid an unfavourable outcome due to overgrowth.
Topics: Heart Neoplasms; Humans; Lipoma; Pericardium; Rare Diseases
PubMed: 33407682
DOI: 10.1186/s13019-020-01379-6 -
The Cochrane Database of Systematic... May 2013Acute myocardial infarction (AMI) is the leading cause of death in developed countries, and current treatment modalities have failed to regenerate the dead myocardium... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute myocardial infarction (AMI) is the leading cause of death in developed countries, and current treatment modalities have failed to regenerate the dead myocardium resulting from the ischemic damage. Stem cells have the potential to regenerate the damaged myocardium. These cells can be mobilized from the bone marrow by factors such as granulocyte colony stimulating factor (G-CSF).
OBJECTIVES
To assess the effects of stem cell mobilization following granulocyte colony stimulating factor therapy in patients with acute myocardial infarction.
SEARCH METHODS
We searched CENTRAL (The Cochrane Library Issue 4, 2010), MEDLINE (1950 to November week 3, 2010), EMBASE (1980 to 2010 week 48), BIOSIS Previews (1969 to 30 November 2010), ISI Science Citation Index Expanded (1970 to 4 December 2010) and ISI Conference Proceedings Citation Index - Science (1990 to 4 December 2010). We also checked reference lists of articles.
SELECTION CRITERIA
We included randomized controlled trials including participants with a clinical diagnosis of AMI who were randomly allocated to the subcutaneous administration of G-CSF through a daily dose of 2.5, 5 or 10 microgram/kg for four to six days or placebo. No age or other restrictions were applied for the selection of patients.
DATA COLLECTION AND ANALYSIS
Two authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data regarding the clinical efficacy and adverse outcomes. Disagreements were resolved by the third author.
MAIN RESULTS
We included seven trials reported in 30 references in the review (354 participants). In all trials, G-CSF was compared with placebo preparations. Dosage of G-CSF varied among studies, ranging from 2.5 to 10 microgram/kg/day. Regarding overall risk of bias, data regarding the generation of randomization sequence and incomplete outcome data were at a low risk of bias; however, data regarding binding of personnel were not conclusive. The rate of mortality was not different between the two groups (RR 0.64, 95% CI 0.15 to 2.80, P = 0.55). Regarding safety, the limited amount of evidence is inadequate to reach any conclusions regarding the safety of G-CSF therapy. Moreover, the results did not show any beneficial effects of G-CSF in patients with AMI regarding left ventricular function parameters, including left ventricular ejection fraction (RR 3.41, 95% CI -0.61 to 7.44, P = 0.1), end systolic volume (RR -1.35, 95% CI -4.68 to 1.99, P = 0.43) and end diastolic volume (RR -4.08, 95% CI -8.28 to 0.12, P = 0.06). It should also be noted that the study was limited since the trials included lacked long enough follow up durations.
AUTHORS' CONCLUSIONS
Limited evidence from small trials suggested a lack of benefit of G-CSF therapy in patients with AMI. Since data of the risk of bias regarding blinding of personnel were not conclusive, larger RCTs with appropriate power calculations and longer follow up durations are required in order to address current uncertainties regarding the clinical efficacy and therapy-related adverse events of G-CSF treatment.
Topics: Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Mobilization; Humans; Myocardial Infarction; Randomized Controlled Trials as Topic; Recurrence
PubMed: 23728682
DOI: 10.1002/14651858.CD008844.pub2 -
Annals of Noninvasive Electrocardiology... Apr 2003Arrhythmogenic right ventricular dysplasia (ARVD) is characterized by progressive replacement of RV myocardium with fibro-adipose tissue thought to be responsible for... (Review)
Review
BACKGROUND
Arrhythmogenic right ventricular dysplasia (ARVD) is characterized by progressive replacement of RV myocardium with fibro-adipose tissue thought to be responsible for the presence of late potentials (LP) detected by SAECG. The general consensus on the role of SAECG in the diagnosis and prognosis of patients with ARVD is lacking. The purpose of this systematic review was to better define the role of SAECG in ARVD.
METHODS
An extensive review of literature was done to specifically describe the prevalence of LP in ARVD and its determinants, explore the various options available to improve the diagnostic ability of SAECG, and provide recommendations for proper utilization of this technique.
RESULTS
LPs are frequent in ARVD (47-100%), and more prevalent in severe disease and in patients with documented spontaneous VT. SAECG is a useful test in following the characteristic evolutivity of the disease. 4-16% of normal family members of patients with ARVD also have abnormal SAECG results. Detection of LP in ARVD can be improved by employing a high-pass filter of 25 Hz and specifically looking for changes in the Z leads.
CONCLUSIONS
SAECG testing should be considered a standard part of the evaluation of patients with known or suspected ARVD. Further research is needed to confirm the value of SAECG testing in predicting arrhythmia risk and assessing the rate of disease progression, as well as to determine if greater prevalence of SAECG abnormalities in family members of patients with ARVD represents early detection of ARVD. The ongoing multidisciplinary study of right ventricular dysplasia will hopefully answer some of these questions.
Topics: Action Potentials; Arrhythmogenic Right Ventricular Dysplasia; Electrocardiography; Humans; Risk Assessment; Signal Processing, Computer-Assisted
PubMed: 12848791
DOI: 10.1046/j.1542-474x.2003.08204.x -
BMC Cardiovascular Disorders Jun 2016This study is a systematic review and meta-analysis of the diagnostic value of cardiovascular magnetic resonance (CMR) in cardiac amyloidosis (CA). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This study is a systematic review and meta-analysis of the diagnostic value of cardiovascular magnetic resonance (CMR) in cardiac amyloidosis (CA).
METHODS
A wide variety of electronic databases were searched for studies of CMR that reported the diagnostic accuracy in patients with suspected CA. Research manuscripts were subjected to further systematic review and meta-analysis. Methodological evaluation was performed under the guidance of the Quality Assessment of Diagnostic Accuracy Studies -2 (QUADAS-2). Heterogeneity was assessed, and a random-effects model was used to assess the diagnostic effects of CMR on pooled sensitivity, pooled specificity, and summary receiver operating characteristics (SROC).
RESULTS
Seven studies that reported the performance of CMR for CA were included in the present systematic review, among which five studies (257 patients) that evaluated the diagnostic accuracy of late gadolinium enhancement (LGE) CMR were analyzed in the present meta-analysis. Heterogeneity was observed only in specificity. A summary sensitivity and specificity of 85 % (95 % CI: 77-91 %) and 92 % (95 % CI: 83-97 %) indicated a high diagnostic accuracy of LGE for CA. The AUC of SROC curve was 0.9530, suggesting that LGE is an effective way of diagnosing patients with possible cardiac involvement in amyloidosis.
CONCLUSIONS
LGE-CMR seems to have a relatively high diagnostic accuracy for amyloidosis patients with possible cardiac involvement. Combined CMR techniques may provide important information for the selection of suitable therapy.
Topics: Aged; Amyloidosis; Area Under Curve; Cardiomyopathies; Contrast Media; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Myocardium; Predictive Value of Tests; Prognosis; ROC Curve; Reproducibility of Results
PubMed: 27267362
DOI: 10.1186/s12872-016-0311-6 -
PloS One 2014Heart failure (HF) is an important covariate and outcome in studies of elderly populations and cardiovascular disease cohorts, among others. Administrative data is... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Heart failure (HF) is an important covariate and outcome in studies of elderly populations and cardiovascular disease cohorts, among others. Administrative data is increasingly being used for long-term clinical research in these populations. We aimed to conduct the first systematic review and meta-analysis of studies reporting on the validity of diagnostic codes for identifying HF in administrative data.
METHODS
MEDLINE and EMBASE were searched (inception to November 2010) for studies: (a) Using administrative data to identify HF; or (b) Evaluating the validity of HF codes in administrative data; and (c) Reporting validation statistics (sensitivity, specificity, positive predictive value [PPV], negative predictive value, or Kappa scores) for HF, or data sufficient for their calculation. Additional articles were located by hand search (up to February 2011) of original papers. Data were extracted by two independent reviewers; article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Using a random-effects model, pooled sensitivity and specificity values were produced, along with estimates of the positive (LR+) and negative (LR-) likelihood ratios, and diagnostic odds ratios (DOR = LR+/LR-) of HF codes.
RESULTS
Nineteen studies published from 1999-2009 were included in the qualitative review. Specificity was ≥95% in all studies and PPV was ≥87% in the majority, but sensitivity was lower (≥69% in ≥50% of studies). In a meta-analysis of the 11 studies reporting sensitivity and specificity values, the pooled sensitivity was 75.3% (95% CI: 74.7-75.9) and specificity was 96.8% (95% CI: 96.8-96.9). The pooled LR+ was 51.9 (20.5-131.6), the LR- was 0.27 (0.20-0.37), and the DOR was 186.5 (96.8-359.2).
CONCLUSIONS
While most HF diagnoses in administrative databases do correspond to true HF cases, about one-quarter of HF cases are not captured. The use of broader search parameters, along with laboratory and prescription medication data, may help identify more cases.
Topics: Aged; Aged, 80 and over; Clinical Coding; Databases, Factual; Diagnostic Errors; Heart Failure; Humans; Myocardium
PubMed: 25126761
DOI: 10.1371/journal.pone.0104519 -
Scientific Reports Dec 2019Cardiac natriuretic peptides (NPs) play a fundamental role in maintaining cardiovascular (CV) and renal homeostasis. Moreover, they also affect glucose and lipid... (Meta-Analysis)
Meta-Analysis
Cardiac natriuretic peptides (NPs) play a fundamental role in maintaining cardiovascular (CV) and renal homeostasis. Moreover, they also affect glucose and lipid metabolism. We performed a systematic review and meta-analysis of studies investigating the association of NPs with serum lipid profile. A PubMed and Scopus search (2005-2018) revealed 48 studies reporting the association between NPs and components of lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglycerides (TG)]. Despite high inconsistency across studies, NPs levels were inversely associated with TC [k = 32; pooled r = -0.09; I = 90.26%], LDLc [k = 31; pooled r = -0.09; I = 82.38%] and TG [k = 46; pooled r = -0.11; I = 94.14%], while they were directly associated with HDLc [k = 41; pooled r = 0.06; I = 87.94%]. The relationship with LDLc, HDLc and TG lost significance if only studies on special populations (works including subjects with relevant acute or chronic conditions that could have significantly affected the circulating levels of NPs or lipid profile) or low-quality studies were taken into account. The present study highlights an association between higher NP levels and a favorable lipid profile. This confirms and extends our understanding of the metabolic properties of cardiac NPs and their potential in CV prevention.
Topics: Humans; Lipids; Myocardium; Natriuretic Peptides; Publication Bias
PubMed: 31844088
DOI: 10.1038/s41598-019-55680-z -
Thyroid : Official Journal of the... Jun 2020Fibrotic diseases have an unclear etiology and poor prognosis. Fluctuations in thyroid function may play a role in the development of fibrosis, but evidence is... (Meta-Analysis)
Meta-Analysis
Fibrotic diseases have an unclear etiology and poor prognosis. Fluctuations in thyroid function may play a role in the development of fibrosis, but evidence is fragmented and inconclusive. This systematic review and meta-analysis aimed to investigate the association of thyroid function with fibrotic diseases of the liver, heart, and lung in humans. We searched PubMed, Medline Ovid, Embase Ovid, and Web-of-Science for studies published from inception to 14 June 2019, to identify observational studies that investigated the association of thyroid function with fibrosis of the liver, heart, and lung in humans. Study quality was evaluated by the Newcastle-Ottawa Scale. The Mantel-Haenszel method was used to pool the odds ratios (ORs) of studies investigating the association of hypothyroidism with liver fibrosis. Of the 2196 identified articles, 18 studies were included in the systematic review, of which 11 studies reported on liver fibrosis, 4 on myocardial fibrosis, and 3 on pulmonary fibrosis. The population sample size ranged from 36 to 7259 subjects, with median mean age 51 years (range, 36-69) and median percentage of women 53 (range, 17-100). The risk of bias of studies was low to moderate to high. Higher serum thyrotropin and lower thyroid hormone levels were generally associated with higher likelihood of fibrosis. Compared with euthyroidism, overt and subclinical hypothyroidism was associated with a higher likelihood of fibrosis in the liver (six of seven studies), heart (three of three studies), and lung (three of three studies). Based on the results of the seven studies included in the meta-analysis, overt and subclinical hypothyroidism was associated with an increased risk of liver fibrosis (pooled OR, 2.81; 95% confidence interval [CI], 1.74-4.53; heterogeneity, 31.4%; pooled OR, 2.12; CI, 1.45-3.12; heterogeneity, 0%; respectively), without evidence of publication bias. This study suggests that low thyroid function is associated with increased likelihood of chronic fibrotic diseases of the liver, heart, and lung. However, the evidence is mainly based on cross-sectional data. Prospective studies and randomized clinical trials are needed to investigate the potential efficacy of thyroid hormone and its analogs on the occurrence and progression of fibrosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Fibrosis; Humans; Liver; Lung; Male; Middle Aged; Myocardium; Thyroid Gland; Thyroid Hormones; Young Adult
PubMed: 31910097
DOI: 10.1089/thy.2019.0572