scholarly journals Safety and effectiveness of Enhanced External Counterpulsation (EECP) in Refractory Angina Patients: Systematic Reviews and Meta-Analysis

2021 ◽  
Author(s):  
Seyed Mansoor Rayegani ◽  
Saeed Heidari ◽  
Majid Maleki ◽  
Maryam Seyed-Nezhad ◽  
Maryam Heidari ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Walking Distance ◽  
Cochrane Library ◽  
Refractory Angina ◽  
Exclusion Criteria ◽  
External Counterpulsation ◽  
Significant Difference ◽  
Enhanced External Counterpulsation

Enhanced external counterpulsation (EECP) is believed to be a non-invasive treatment for coronary artery disease and angina. The aim of this study was to determine the safety and effectiveness of EECP in refractory angina patients through a systematic reviews and meta-analysis. We conducted a comprehensive search of the literature published on PubMed, Cochrane library, Scopus, ScienceDirect, Trip Database and Google Scholar databases using appropriate keywords and specific strategy with no time limit. Having selected and screened the studies based on the defined inclusion and exclusion criteria and evaluating their quality based on the Cochrane checklist. For the meta-analysis,the Mantel-Haenszel method or the generic Inverse Variance was used. Analyses were done with Review Manager 5.2 software. A number of 299 studies were initially reviewed and finally, seventeen studies were included in the meta-analysis based on the inclusion and exclusion criteria. Also, thirteen outcomes were analyzed and the results of meta-analysis in twelve outcomes including (Systolic Blood Pressure (7 studies), Diastolic Blood Pressure (7 studies), Pulse Pressure (4 studies), Mean Arterial Pressures (4 studies), Heart Rate (6 studies), Angina episodes (7 studies), Walking distance (2 studies),Canadian Cardiovascular Society classification (6 studies), Flow-Mediated Dilation (3 studies), Daily Nitrate Usage (4 studies), Exercise Treadmill Test-Time (2 studies), ST-segment depression (2 studies)demonstrated a significant clinical advantage in the EECP treatment effectiveness in patients with angina. No significant difference was observed regarding EECP usefulness (P = 0.18) in the outcome of brachial artery diameter (2 studies). Based on the meta-analysis, the results indicate the safety and effectiveness of EECP in patients with angina pectoris and indicate the usefulness of this treatment in these patients. In general, the authors believe that the general conclusion in this regard requires some studies with a large sample size and a control group assignment.

scholarly journals Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis

2016 ◽  
Vol 41 (3) ◽  
pp. E7 ◽  
Author(s):  
Mingliang He ◽  
Leping Ouyang ◽  
Shengwen Wang ◽  
Meiguang Zheng ◽  
Anmin Liu
Keyword(s):  
Systematic Reviews ◽  
Operative Time ◽  
Meta Analysis ◽  
Catheter Insertion ◽  
Cochrane Library ◽  
Number Needed To Treat ◽  
Shunt Failure ◽  
Peritoneal Catheter ◽  
Significant Difference ◽  
Mini Laparotomy

OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25–0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8–23), operative time was shorter (mean difference [MD], −12.84; 95% CI −20.68 to −5.00; p = 0.001), and blood loss was less (MD −9.93, 95% CI −17.56 to −2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD −1.77, 95% CI −3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.

Abstract P191: Improved Systolic and Diastolic Blood Pressure After Enhanced External Counterpulsation Therapy Combined With a Lifestyle Modification Program

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Murtaza Bharmal ◽  
Michael Share ◽  
Sara Soulati ◽  
Dean Chiaro ◽  
Ronald Weaver ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Lifestyle Modification ◽  
Lifestyle Modifications ◽  
Antihypertensive Medications ◽  
External Counterpulsation ◽  
Nitric Oxide Release ◽  
Number Of Patients ◽  
Significant Difference ◽  
Enhanced External Counterpulsation

Background: Enhanced external counterpulsation (EECP) is a noninvasive, FDA approved therapy for refractory angina. Because EECP increases nitric oxide release, it may have an ancillary benefit on blood pressure (BP). Methods: We measured changes in BP at baseline over 35 sessions of EECP, which included lifestyle coaching. Supine blood pressure was measured before and after every EECP session by trained healthcare technicians with calibrated manual sphygmomanometers. Results: 404 patients (age 67.2 ± 10.0, 50% male - 200/404, 77% African American - 311/404) completed the program. Hypertensive subjects at baseline (37% - 150/404) showed an improvement in both systolic and diastolic BP (Table). Notably, there was a marked reduction in BP after the first EECP session, with a further, more modest reduction by the end of the 35 sessions. Weight decreased by a mean 3.0 lbs (p<0.001) and there was no significant difference in the number of patients receiving antihypertensive medications before or after completing EECP (46% - 184/404 vs. 47% - 189/404, p=0.62). Conclusions: EECP therapy leads to a reduction in both systolic and diastolic blood pressure, which is most prominent in patients with baseline hypertension. These results maintain throughout the 35 sessions. These results reflect observational data from one highly experienced clinic in which EECP is routinely combined with daily coaching on vegan plant-based lifestyle modifications and exercise. Further studies are indicated to investigate this observed phenomenon to both confirm these findings as well as assess for the length and durability of the effect.

Abstract P100: Enhanced External Counterpulsation Reduces Central Blood Pressure In Stable Angina Patients: A Meta Analysis

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Elizabeth Lindemann ◽  
Kevin Pham ◽  
Gautam Kedia ◽  
Ananth Prasad ◽  
Sachin A Shah
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Systolic Blood Pressure ◽  
Stable Angina ◽  
Augmentation Index ◽  
Meta Analysis ◽  
Central Hemodynamics ◽  
External Counterpulsation ◽  
Before And After ◽  
Enhanced External Counterpulsation

Introduction: Emerging evidence suggests central systolic blood pressure (cSBP) and augmentation index are superior predictors of adverse cardiovascular outcomes as compared to peripheral systolic blood pressure (pSBP). Enhanced external counterpulsation (EECP) is a non-invasive treatment modality approved for the management of refractory angina. The degree of benefit from EECP on central hemodynamics and arterial stiffness remains unknown. This meta-analysis evaluated the effect of EECP on peripheral (office) blood pressure and central hemodynamic parameters. Methods: A comprehensive literature search was conducted in Pubmed, CINAHL, and Cochrane Library databases. All prospective clinical trials assessing the impact of EECP in patients with stable angina and CAD were included. Studies were excluded for not completing a full course of EECP, having a baseline peripheral systolic blood pressure &lt100 mmHg, or not reporting adequate data for analysis. The primary endpoint was the change in cSBP before and after EECP. The change in pSBP, pDBP, cDBP, and augmentation index before and after EECP were also assessed. The weighted mean difference using the DerSimonian and Laird random-effect model was utilized for determining the change in each parameter before and after EECP. Statistical heterogeneity was evaluated using the Egger’s bias statistic. Results: Five studies containing 137 unique patients were included for the cSBP analysis. cSBP was reduced significantly by -7.56 mmHg (95% CI -11.83 to -3.28; Cochrane Q=1.81) post-EECP. In the same set of studies, pSBP was reduced significantly by -9.65 mmHg (95% CI -14.32 to -4.98) post-EECP. pDBP [-4.67 mmHg (95% CI -8.56 to -0.77)] was reduced post-EECP, while no changes were evident in cDBP. Augmentation index was reduced by -3.74% (95% CI -7.05 to -0.43) post-EECP. Two studies included a sham-EECP intervention arm and demonstrated no significant changes in cSBP [0.67 mmHg (95% CI -5.66 to 7.01)] or other parameters. Conclusion: EECP significantly reduced cSBP and pSBP by approximately 8 mmHg and 10 mmHg respectively. EECP also demonstrated a mild improvement in arterial stiffness, which translates to reduced wasted left ventricular energy and myocardial oxygen demand. In patients with stable angina and CAD, EECP exerts beneficial effects in both peripheral and central hemodynamics but whether these benefits are sustained over a longer duration need further exploration.

Abstract 14036: Enhanced External Counterpulsation Reduces Blood Pressure in Patients With Chronic Stable Angina: A Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bradley Williams ◽  
Mehak Aggarwal ◽  
Cole Kiser ◽  
Krishnaswami Vijayaraghavan ◽  
Sachin A Shah
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Publication Bias ◽  
Stable Angina ◽  
Meta Analysis ◽  
Chronic Stable Angina ◽  
External Counterpulsation ◽  
Statistical Heterogeneity ◽  
The Impact ◽  
Enhanced External Counterpulsation

Background: Hypertension is a modifiable risk factor for ASCVD. Enhanced External Counterpulsation (EECP ® ) is an FDA-approved, non-invasive treatment modality for patients with angina and symptoms of ischemic heart failure. Various studies have demonstrated hemodynamic changes with EECP ® therapy, but the true magnitude of benefit remains unknown. We conducted a meta-analysis to assess the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) post- EECP ® therapy. Methods: A literature search across multiple databases was conducted from its inception to March 2020. Studies evaluating the impact of EECP ® in chronic stable angina patients that reported systolic and diastolic blood pressures were extracted. Human studies published in English, where patients completed 35 hours of EECP ® (administered as 1-hour sessions) were included for analysis. Studies that reported data in multiple arms were treated as individual studies. The weighted mean difference from baseline for SBP and DBP was calculated using the DerSimonian-Laird random-effects model. Statistical heterogeneity was assessed by the I 2 statistic with publication bias evaluated using the Egger bias statistic. Subgroup analyses were performed to assess for clinical heterogeneity. Results: We identified 272 articles, of which 15 unique studies (n=659) reporting data on systolic and diastolic blood pressure were included. Post- EECP ® treatment, SBP decreased by 8.9 mmHg (95% CI 4.0 to 13.7 mmHg, I 2 =87.3%) and DBP reduced by 3.6 mmHg (95% CI 2.1 to 5.0 mmHg, I 2 =38.9%). Patients with a baseline SBP 130 mmHg appear to derive greater benefit (SBP reduced by 13.0 mmHg, 95% CI 8.3 to 17.6, I 2 =70.4%) compared to patients with a baseline SBP<130 (SBP reduced by 3.2 mmHg, 95% CI 0.4 to 6.0, I 2 =25.2). The Egger bias statistic showed no publication bias for the primary endpoints (both p-values>0.33). Conclusion: EECP ® treatment reduced SBP and DBP by over 8 and 3 mmHg respectively. The pleiotropic benefits from EECP ® provide additional hypertension control in patients with chronic stable angina.

Effects on blood pressure in patients with refractory angina pectoris after enhanced external counterpulsation

2010 ◽  
Vol 19 (5) ◽  
pp. 287-294 ◽  
Author(s):  
Susanne Bondesson ◽  
Thomas Pettersson ◽  
Ola Ohlsson ◽  
Ingalill R. Hallberg ◽  
Angelica Wackenfors ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Angina Pectoris ◽  
Refractory Angina ◽  
External Counterpulsation ◽  
Refractory Angina Pectoris ◽  
Enhanced External Counterpulsation

Enhanced external counterpulsation improves systolic blood pressure in patients with refractory angina

2008 ◽  
Vol 156 (6) ◽  
pp. 1217-1222 ◽  
Author(s):  
Alex R. Campbell ◽  
Daniel Satran ◽  
Andrey G. Zenovich ◽  
Kayla M. Campbell ◽  
Julia C. Espel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Refractory Angina ◽  
External Counterpulsation ◽  
Enhanced External Counterpulsation

scholarly journals Shexiang Baoxin Pills as an Adjuvant Treatment for Chronic Heart Failure: A System Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Taiwei Dong ◽  
Jian Wang ◽  
Xiao Ma ◽  
Rong Ma ◽  
Jianxia Wen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Natriuretic Peptide ◽  
Adjuvant Treatment ◽  
Conventional Treatment ◽  
Meta Analysis ◽  
Walking Distance ◽  
Cochrane Library ◽  
Efficacy Rate ◽  
Significant Difference

Background. Shexiang Baoxin pills (SXBXP), as a Traditional Chinese Medicine, are widely used for chronic heart failure in China. It is essential to systematically assess the efficacy and safety of SXBXP as an adjuvant treatment for chronic heart failure. Methods. Seven English and Chinese electronic databases (PubMed, Embase, Cochrane Library, CBM, Wanfang, VMIS, and CNKI) were searched from inception to July 2017. The Cochrane Risk of Bias tool was used to evaluate the methodological quality of eligible studies. Meta-analysis was performed by Review Manager 5.3. Results. A total of 27 RCTs with 2637 participants were included in this review. Compared to conventional treatment, SXBXP combined with conventional treatment showed potent efficacy when it came to the total efficacy rate (OR, 3.88; 95% CI, 2.87, 5.26; P<0.00001), B-type natriuretic peptide (BNP) (MD = −66.95; 95% CI, −108.57, −25.34; P=0.002), N-terminal pro-brain natriuretic peptide (NT-ProBNP) (MD = −0.15; 95% CI, −0.21, −0.09; P<0.00001), six-minute walking distance (6-MWD) (MD = 38.57; 95% CI, 28.47, 48.67; P<0.00001), cardiac output (CO) (MD = 0.84; 95% CI, 0.68, 0.99; P<0.00001), and Stroke Volume (SV) (MD = 7.43; 95% CI, 4.42, 10.44, P<0.00001). The pooled subgroup analysis indicated that there was a significant difference between SXBXP plus conventional treatment and conventional treatment alone in short term course (OR = 3.51; 95% CI, 2.28, 5.40; P<0.00001), in middle period of treatment (OR = 5.01; 95% CI, 2.61, 9.60; P<0.00001), and in long-term course (OR = 3.77; 95% CI, 2.13, 6.67; P<0.00001). No serious adverse events or reactions were mentioned in these RCTs. Conclusions. As an adjuvant drug, this study suggested that SXBXP provide an obvious efficacy for the treatment of CHF. However, due to small samples and generally low quality studies being applied in this study, more rigorous and well-designed RCTs are needed to confirm these findings.

scholarly journals 5-HT3 receptor antagonists for the prevention of postoperative shivering: a meta-analysis

2016 ◽  
Vol 44 (6) ◽  
pp. 1174-1181 ◽  
Author(s):  
Chengmao Zhou ◽  
Yu Zhu ◽  
Zhen Liu ◽  
Lin Ruan
Keyword(s):  
Relative Risk ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Comparable Efficacy ◽  
Controlled Trials ◽  
Receptor Antagonists ◽  
Exclusion Criteria ◽  
Randomized Controlled ◽  
Significant Difference ◽  
The Cochrane Library

Objective We evaluated the efficacy of 5-HT3 receptor antagonists for the prevention of postoperative shivering. Methods We searched PubMed, the Cochrane Library, EMBASE and Web of Knowledge to find randomized controlled trials (RCT) of 5-HT3 receptor antagonists for the prevention of postoperative shivering. Two researchers independently screened studies, extracted data, and assessed quality in accordance with the inclusion and exclusion criteria, and then conducted a meta-analysis using RevMan 5.2. Results Ultimately, 14 RCTs that included 980 patients were included in the analysis. We found that: 1) the incidence of shivering was significantly lower in 5-HT3 groups than placebo groups (relative risk, [RR] = 0.48, 95% confidence interval [CI] 0.40 – 0.58); 2) there was no significant difference in the incidence of shivering between 5-HT3 groups and meperidine groups (RR = 0.89, 95% CI 0.60 – 1.34). Conclusion 5-HT3 receptor antagonists appear to prevent postoperative shivering, with a broadly comparable efficacy to meperidine.

Effect of Bleaching Gel Concentration on Tooth Color and Sensitivity: A Systematic Review and Meta-analysis

2020 ◽  
Vol 45 (3) ◽  
pp. 265-275 ◽  
Author(s):  
MMA Pontes ◽  
JML Gomes ◽  
CAA Lemos ◽  
RS Leão ◽  
SLD Moraes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hydrogen Peroxide ◽  
Systematic Reviews ◽  
Color Change ◽  
Meta Analysis ◽  
Cochrane Library ◽  
High Concentration ◽  
Tooth Sensitivity ◽  
Bleaching Procedure ◽  
Significant Difference

SUMMARY Objective: The aim of this systematic review and meta-analysis was to evaluate a high concentration of hydrogen peroxide (35%) regarding tooth sensitivity and color change in tooth bleaching in comparison to low concentrations (6% to 20%). Methods and Materials: This review was conducted using the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and is registered on the Prospective Register of Systematic Reviews (CRD42017064493). The PICO question was “Does a concentration of hydrogen peroxide ≥35% using in-office bleaching procedure contribute to greater tooth sensitivity?” A search was made in PubMed/MEDLINE, Scopus, and the Cochrane Library. Results: Fourteen studies were selected for the qualitative analysis and seven for quantitative analysis. A total of 649 patients were evaluated (mean age: 36.32 years; range: 13.9 to 31 years), and the follow-up period ranged from one week to 12 months. The meta-analysis demonstrated that tooth sensitivity was higher in the patients submitted to treatment involving a high concentration of hydrogen peroxide (0.67; 95% confidence interval [CI]: 0.44 to 1.03; p=0.04; I2: 56%), and a significant difference was found regarding objective color ΔE (1.53; 95% CI: 2.99 to 0.08; p&lt;0.0001; I2: 82%) but no significant difference was found regarding subjective color ΔSGU (0.24; CI: 0.75 to 1.23; p&lt;0.00001; I2: 89%). Conclusions: This study indicated that a lower concentration of hydrogen peroxide causes less tooth sensitivity and better effectiveness in objective color change (ΔE); however, there is no difference between them related to subjective color (ΔSGU).

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