Left ventricular contractile reserve as a determinant of adverse clinical outcomes: a systematic review

2022 ◽  
Author(s):  
Paul M. Thein ◽  
Sam Mirzaee ◽  
James D. Cameron ◽  
Arthur Nasis
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Contractile Reserve

scholarly journals Clinical outcomes of paediatric patients supported by the Berlin Heart EXCOR: a systematic review

2019 ◽  
Vol 56 (5) ◽  
pp. 830-839 ◽  
Author(s):  
Sofie Rohde ◽  
Christiaan F J Antonides ◽  
Michiel Dalinghaus ◽  
Rahatullah Muslem ◽  
Ad J J C Bogers
Keyword(s):  
Systematic Review ◽  
Heart Transplantation ◽  
Clinical Outcomes ◽  
Mortality Rates ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Optimal Timing ◽  
Assist Device ◽  
Ventricular Assist ◽  
Berlin Heart

Summary Ventricular assist devices (VADs) are widely accepted as therapy to bridge children to heart transplantation. We provide a systematic review of the current state of clinical outcomes in children after paediatric VAD support by the Berlin Heart EXCOR (BH EXCOR) device. A systematic literature search was performed in April 2018. Studies reporting clinical outcomes in at least 15 children supported by a BH EXCOR VAD were included. Additionally, we focused on outcomes in small children and compared outcomes of children supported by a left ventricular assist device (LVAD) versus children supported by a biventricular assist device (BiVAD). Eighteen publications fulfilled the inclusion criteria and were included in this systematic review. Mortality rates ranged from 6.3% [confidence interval (CI) 0.0–18.1%] to 38.9% (2.8–75.0%) while transplantation rates ranged from 37.0% (CI 18.8–55.2%) to 72.5% (CI 63.9–81.2%) and successful weaning rates from 0.0% to 20.7% (CI 6.0–35.5%). In children under 1 year of age, mortality rates ranged from 20.0% to 55.5% and transplantation rates ranged from 0.0% to 62.5%. BiVAD support seemed to result in worse clinical outcomes than LVAD support. Incidence of stroke ranged from 5.0% to 47.0% in all children supported with the BH EXCOR. Although a high incidence of adverse events such as stroke and pump thrombosis is reported, VAD support should be considered in children with end-stage heart failure awaiting heart transplantation. Further research is warranted, especially on optimal timing of device implantation and anticoagulation regimens.

scholarly journals Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure: A Systematic Review

2015 ◽  
Vol 5 (2) ◽  
pp. 145-156 ◽  
Author(s):  
Renhua Lu ◽  
María-Jimena Muciño-Bermejo ◽  
Leonardo Claudino Ribeiro ◽  
Enrico Tonini ◽  
Carla Estremadoyro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Congestive Heart Failure ◽  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Heart Function ◽  
Left Ventricular ◽  
Disease Stage ◽  
Left Ventricular Ejection ◽  
Cochrane Library

Background: Refractory congestive heart failure (RCHF) is associated with a high mortality rate and is a major contributor to hospital admissions. Peritoneal dialysis (PD) is an option to control volume overload and perhaps improve outcomes in this challenging patient population. The aim of this systematic review is to describe the relative risk-benefit ratio based on data reported regarding the use of PD in RCHF. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic search of PubMed, Embase, and the Cochrane Library was performed to identify relevant studies published from January 1951 to February 2014. Eligible studies selected were prospective or retrospective adult population studies on PD in the setting of RCHF. The following clinical outcomes were used to assess PD therapy: (1) hospitalization rates; (2) heart function; (3) renal function; (4) fluid overload, and (5) adverse clinical outcomes. Summary: Of 864 citations, we excluded 843 citations and included 21 studies (n = 673 patients). After PD, hospitalization days declined significantly (p = 0.0001), and heart function improved significantly (left ventricular ejection fraction: p = 0.0013; New York Heart Association classification: p = 0.0000). There were no statistically significant differences in glomerular filtration rate after PD treatment in non-chronic kidney disease stage 5D patients (p = 0.1065). Among patients treated with PD, body weight decreased significantly (p = 0.0006). The yearly average peritonitis rate was 14.5%, and the average yearly mortality was 20.3%. Key Messages: This systematic review suggests that PD may be an effective and safe therapeutic tool for patients with RCHF.

scholarly journals Clinical outcomes from antihypertensive therapies in moderate or severe aortic stenosis: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Sen ◽  
E Chung ◽  
C Neil ◽  
T Marwick
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Aortic Stenosis ◽  
Clinical Outcomes ◽  
Lower Risk ◽  
Severe Aortic Stenosis ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Coronary Perfusion ◽  
Cochrane Central Register

Abstract Background Hypertension can negatively affect prognosis in moderate or severe aortic stenosis (AS), but antihypertensive therapy (AHT) is often avoided due to possible deleterious effects such as reduced coronary perfusion, left ventricular dysfunction and haemodynamic compromise. Purpose We systematically assessed and compared clinical outcomes in adults with moderate or severe AS treated with and without AHT. Methods Two independent reviewers performed screening, data extraction and risk of bias assessments from a systematic search of the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and grey literature without language restrictions up to September 9, 2019. Conflicts were resolved by the third reviewer. Outcomes of interest included mortality, left ventricular (LV) mass index, systolic blood pressure, diastolic blood pressure, and LV ejection fraction. Meta-analysis with pooled effect sizes using random-effects model, were estimated in R. Results Of 3,024 citations, 30 studies (26,224 patients) were included in the qualitative synthesis and 23 studies in meta-analysis. AHT was associated with favourable clinical outcomes and was well tolerated. AHT was associated with lower risk of all-cause mortality (Risk Ratio (RR)=0.69, 95% CI: 0.53–0.90, p=0.01, Figure). The effect size appears to differ with type of aortic valve replacement (AVR). AHT was associated with lower risk of acute kidney injury post-transcatheter AVR (RR=0.13, 95% CI:0.05–0.35, p=0.007). Favourable outcomes such as improved haemodynamic and echocardiographic parameters were demonstrated in some studies, but when pooled in meta-analysis, the differences did not reach statistical significance. However, heterogeneity was significant across studies. Conclusion This is the first systematic review and meta-analysis to demonstrate that AHT is safe and has a clinical benefit in patients with advanced stages of AS with significant improvement in survival or reduction in mortality without haemodynamic compromise. Further studies are required to determine the best AHT for patients with moderate or severe AS. Forest plot of AHT effect on mortality. Funding Acknowledgement Type of funding source: None

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