Breath acetone concentration: too heterogeneous to constitute a diagnosis or prognosis biomarker in heart failure? A systematic review and meta-analysis

Abstract Introduction: Exhaled breath acetone (ExA) has been investigated as a biomarker for heart failure (HF). Yet, barriers to its use in the clinical field have not been identified. The aim of this systematic review and meta-analysis was to assess the ExA heterogeneity and factors of variability in healthy controls (HC), to identify its relations with HF diagnosis and prognostic factors and to assess its diagnosis and prognosis accuracy in HF patients. Methods: A systematic search was conducted in PUBMED and Web of Science database. All studies with HC and HF patients with a measured ExA were included and studies providing ExA’s diagnosis and prognosis accuracy were identified. Results: Out of 971 identified studies, 18 studies involving 833 HC and 1009 HF patients were included in the meta-analysis. In HC, ExA showed an important heterogeneity (I²=99%). Variability factors were fasting state, sampling type and analytical method. The mean ExA was 1.89 times higher in HF patients vs. HC (782 [531-1032] vs. 413 [347-478] ppbv; p<0.001). One study showed excellent diagnosis accuracy, and one showed a good prognosis value. ExA correlated with New York Heart Association (NYHA) dyspnea (p<0.001) and plasma brain natriuretic peptide (p<0.001). Studies showed a poor definition and reporting of included subjects. Discussion: Despite the between-study heterogeneity in HC, the evidence of an excellent diagnosis and prognosis value of ExA in HF from single studies can be extended to clinical populations worldwide. Factors of variability (ExA procedure and breath sampling) could further improve the diagnosis and prognosis values of this biomarker in HF patients.

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Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: a systematic review and meta-analysis

Heart ◽

10.1136/heartjnl-2017-311412 ◽

2017 ◽

Vol 104 (4) ◽

pp. 306-312 ◽

Cited By ~ 35

Author(s):

Mauro Chiarito ◽

Matteo Pagnesi ◽

Enrico Antonio Martino ◽

Michele Pighi ◽

Andrea Scotti ◽

...

Keyword(s):

Systematic Review ◽

New York ◽

Mitral Regurgitation ◽

Meta Analysis ◽

Heart Association ◽

Class Iii ◽

Term Outcome ◽

Mitral Repair ◽

New York Heart Association ◽

One Year

ObjectivesDifferences in terms of safety and efficacy of percutaneous edge-to-edge mitral repair between patients with functional and degenerative mitral regurgitation (MR) are not well established. We performed a systematic review and meta-analysis to clarify these differences.MethodsPubMed, EMBASE, Google scholar database and international meeting abstracts were searched for all studies about MitraClip. Studies with <25 patients or where 1-year results were not delineated between MR aetiology were excluded. This study is registered with PROSPERO.ResultsA total of nine studies investigating the mid-term outcome of percutaneous edge-to-edge repair in patients with functional versus degenerative MR were included in the meta-analysis (n=2615). At 1 year, there were not significant differences among groups in terms of patients with MR grade≤2 (719/1304 vs 295/504; 58% vs 54%; risk ratio (RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly lower rate of mitral valve re-intervention in patients with functional MR compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR 0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16% (408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77; p=0.18). Functional MR group showed significantly higher percentage of patients in New York Heart Association class III/IV (234/1480 vs 49/583; 16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs 31/220; 23% vs 14%; p=0.03). No differences were found in terms of single leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device embolisation (no events reported in both groups) at 1 year.ConclusionsThis meta-analysis suggests that percutaneous edge-to-edge repair is likely to be an efficacious and safe option in patients with both functional and degenerative MR. Large, randomised studies are ongoing and awaited to fully assess the clinical impact of the procedure in these two different MR aetiologies.

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Meta-analysis of effect of beta-blocker therapy on mortality in patients with New York Heart Association class IV chronic congestive heart failure

The American Journal of Cardiology ◽

10.1016/s0002-9149(00)01114-0 ◽

2000 ◽

Vol 86 (8) ◽

pp. 886-889 ◽

Cited By ~ 22

Author(s):

Sarah L Whorlow ◽

Henry Krum

Keyword(s):

Heart Failure ◽

New York ◽

Meta Analysis ◽

Heart Association ◽

Chronic Congestive Heart Failure ◽

York Heart Association Class ◽

Blocker Therapy ◽

Association Class ◽

New York Heart Association ◽

Class Iv

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Referral Criteria to Palliative Care for Patients With Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.120.006881 ◽

2020 ◽

Vol 13 (9) ◽

Author(s):

Yuchieh Kathryn Chang ◽

Holland Kaplan ◽

Yimin Geng ◽

Li Mo ◽

Jennifer Philip ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

New York ◽

Palliative Care ◽

Heart Association ◽

Emotional Symptoms ◽

Care Needs ◽

Referral Criteria ◽

Patients With Heart Failure ◽

New York Heart Association

Background: Patients with heart failure have significant symptom burden, care needs, and often a progressive course to end-stage disease. Palliative care referrals may be helpful but it is currently unclear when patients should be referred and by whom. We conducted a systematic review of the literature to examine referral criteria for palliative care among patients with heart failure. Methods: We searched Ovid, MEDLINE, Ovid Embase, and PubMed databases for articles in the English language from the inception of databases to January 17, 2019 related to palliative care referral in patients with heart failure. Two investigators independently reviewed each citation for inclusion and then extracted the referral criteria. Referral criteria were then categorized thematically. Results: Of the 1199 citations in our initial search, 102 articles were included in the final sample. We identified 18 categories of referral criteria, including 7 needs-based criteria and 10 disease-based criteria. The most commonly discussed criterion was physical or emotional symptoms (n=51 [50%]), followed by cardiac stage (n=46 [45%]), hospital utilization (n=38 [37%]), prognosis (n=37 [36%]), and advanced cardiac therapies (n=36 [35%]). Under cardiac stage, 31 (30%) articles suggested New York Heart Association functional class ≥III and 12 (12%) recommended New York Heart Association class ≥IV as cutoffs for referral. Prognosis of ≤1 year was mentioned in 21 (21%) articles as a potential trigger; few other criteria had specific cutoffs. Conclusions: This systematic review highlighted the lack of consensus regarding referral criteria for the involvement of palliative care in patients with heart failure. Further research is needed to identify appropriate and timely triggers for palliative care referral.

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