ObjectiveTo systematically review the efficacy of MitraClip therapy in heart failure patients with mitral insufficiency.
MethodsDatabases including PubMed, The Cochrane Library (Issue 11, 2014), EMbase, CBM, CNKI, VIP and WanFang Data were searched from October 2005 to October 2015 to collect before-after controlled studies about the efficacy of MitraClip therapy in heart failure patients with mitral insufficiency. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software.
ResultsA total of 9 studies involving 782 patients were included. The results of meta-analysis showed that, compared with their conditions before treatment, patients after the MitraClip implantation had a declined NYHA class Ⅲ-Ⅳ ratio (RD=0.72, 95%CI 0.60 to 0.85, P<0.000 01), increased left ventricular ejection fraction (LVEF) (MD=-2.97，95%CI -5.06 to -0.89，P<0.005) and improved performance in 6 min walk-test (6-MWT) (MD=-88.73, 95%CI -157.16 to -20.31, P=0.01).
ConclusionMitraClip therapy can, to a certain extent, improve the cardiac function of patients with heart failure and mitral insufficiency. However, further studies are needed to confirm its effects on improving the long-term survival of patients.
Objective To systematically review the efficacy and safety of different SGLT2 inhibitors in the treatment of heart failure. Methods The Cochrane Library, Web of Science, PubMed and EMbase databases were searched for randomized controlled trials on the efficacy and safety of SGLT2 inhibitors in patients with heart failure from inception to July 2, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Network meta-analysis was then performed using Stata 16.0 software. Results A total of 16 randomized controlled trials, including 15 312 patients, involving 5 interventions, namely dapagliflozin, empagliflozin, canagliflozin, sotagliflozin and ertugliflozin were included. Results of network meta-analysis showed that there was no significant difference in the compound outcome of hospitalization for heart failure or cardiovascular death, hospitalization for heart failure, all-cause mortality, risk of cardiovascular mortality and serious adverse reactions among patients with heart failure among 5 different SGLT2 inhibitors (P>0.05). Compared with placebo, both selective and non-selective SGLT2 inhibitors improved the risk of hospitalization for heart failure, hospitalization for heart failure, or compound cardiovascular mortality (P<0.05), while only selective SGLT2 inhibitors improved the risk of cardiovascular mortality, all-cause mortality, and serious adverse events (P<0.05). However, there was no significant difference between them (P>0.05). The area under the cumulative ordering probability curve of selective and non-selective SGLT2 inhibitors ranked first and second, except for the combined outcome of heart failure or cardiovascular death. Conclusion The current evidence indicates that there is no significant difference in the efficacy and safety of the 5 different SGLT2 inhibitors in the treatment of heart failure, and there is no significant difference between selective SGLT2 inhibitors and non-selective SGLT2 inhibitors. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusion.
Abstract: The ventricle assist device has emerged as an important therapeutic option in the treatment of both acute and chronic heart failure. The blood pumps which are the major components of ventricle assist devices have also progressed to the third generation. The magnetic and/or liquid levitation technologies have been applied into the third generation blood pumps. The impellers which drive blood are levitated in the blood pumps. The third generation blood pumps are mainly composed of the levitation system and the driving system. The development of the third generation blood pumps has three stages: the stage of foreign motor indirectly driving the impeller with the levitation and driving system separated, the stage of motor directly driving the impeller with the levitation and driving system separated, and the stage of levitation system integrated with the driving system. As the impellers do not contact with other structures, the third generation blood pumps possess the advantages of low thrombosis, less hemolysis and high energy efficiency ratio. Currently most of the third generation blood pumps are in the research stage, but a few number of them are used in clinical trials or applying stage. In this article, the history, classification, mechanism and research situation of the third generation blood pumps are reviewed.
Abstract： Among all kinds of heart diseases, heart failure is the leading cause of death. In recent years, the treatment of terminal heart failure has increasingly become a great challenge to cardiovascular clinical physicians. The limitations of routine medical therapy and surgical interventions, and the shortage of donor hearts have led to the rapid development of mechanical circulation support devices. As the joint research and development of electric machine, mechanical engineering, fluid mechanics, materials science, medical science and some other related subjects, exploring a new type of longterm implantable blood pump has become a hot issue. Axial flow blood pump has the advantages of simple structure, light weight, high flow and efficiency, easy implantation and removal, and at the same time, it does not need to install artificial valves, which can greatly reduce the risk of thrombosis. Compared with the centrifugal pump, axial flow blood pump is smaller and causes much less damage to the blood. At present, axial flow blood pump research has become a focus in cardiac surgery and biomedical engineering field. This article is going to review the operation principles and characteristics of axial flow blood pump, and some key technical issues of current axial flow blood pump research.
Heart failure with preserved ejection fraction (HFpEF) is the main type of heart failure (HF), accounting for more than half of the incidence of HF. However, the etiology, pathogenesis, treatment and prognosis of HFpEF are still not fully understood. Recommendations for HFpEF are in different chapters in the 2022 AHA/ACC/HFSA guideline for the management of heart failure. This paper interpreted the definition, stage, diagnosis, epidemiology, clinical evaluation, stage treatment, acute attack stage, comorbidity management, vulnerable population and research prospect of HFpEF, which aimed to provide the latest thinking in terms of the management of HFpEF for clinicians.
Heart failure (HF) is a symptoms caused by various diseases. As the myocardial contractility and/or diastolic weakening, the cardiac output decreased, when it can not satisfy the needs of the body, a series of symptoms and signs occurs. HF is an end-stage performance of heart disease, and is also a major factor of mortality. The morbidity of heart failure increased as peoples enter the aging. Despite the continuous improvement of drug treatment,the morbidity and mortality of HF remains high. At present, nondrug treatment of heart failure get more and more attention to clinicians. Surgical methods gets more innovation.Medical intervention has been introducted new auxiliary facilities, and genetics and stem cell technology bring new hope to it’s treatment. This article reviews the HF surgery, nterventional treatment and its related gene and cell therapy and research recently.
Sodium-glucose cotransporter (SGLT) -2 inhibitors is a new type of oral sugar-lowering drug. Instead of relying on insulin, it lowers blood sugar by inhibiting the reabsorption of near-curvy tube glucose, which is drained from the urine. SGLT-2 inhibitors not only have a sugar-lowering effect, but also benefit significantly in cardiovascular disease, and this drug has the advantages of permeable diuretic, reducing capacity load, and improving ventricular remodeling. SGLT-2 inhibitors can improve the diastolic function of patients with heart failure with preserved ejection fraction (HFpEF) and reduce the risk of adverse cardiovascular events. SGLT-2 inhibitors can benefit patients with HFpEF. Therefore, this article will discuss the progress of SGLT-2 inhibitors in HFpEF.
ObjectiveTo systematically review the efficacy and safety of angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB) in the treatment of patients with diastolic heart failure (DHF).
MethodsPubMed, EMbase, The Cochrane Library (Issue 11, 2014), CNKI, WanFang Data, VIP and CBM were electronically searched from inception to November 2014 for randomized controlled trials (RCTs) of ACEI/ARB for DHF patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software.
ResultsA total of 22 RCTs involving 9 557 patients were included. The results of meta-analysis indicated that, compared with the control group, the ACEI/ARB group had significant improvements in exercise capacity (6-minute walk distance:SMD=0.02, 95% CI 0.05 to 0.38, P=0.01; Exercise time:MD=40.58, 95% CI 14.06 to 67.10, P=0.003) and diastolic function (E/A ratio:MD=0.20, 95% CI 0.09 to 0.31, P=0.000 4; E/E' ratio:MD=-1.69, 95% CI -2.11 to -1.27, P<0.000 01). In addition, compared with the control treatment, ACEI/ARB could significantly decrease the serum BNP level (SMD=-0.44, 95% CI -0.72 to -0.16, P=0.002) and NT-proBNP level (SMD=-0.68, 95% CI -1.24 to -0.12, P=0.02).
ConclusionCurrent evidence shows that ACEI/ARB can improve the exercise capacity and diastolic function, and reduce the levels of serum BNP and NT-proBNP in DHF patients. Due to the limited quality of the included studies and discrepancies in the diagnostic criteria of DHF, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the efficacy of Tai Chi on patients with heart failure.MethodsDatabases including CNKI, VIP, WanFang Data, Web of Science, PubMed, EMbase and The Cochrane Library (Issue 8, 2016) were searched from inception to August, 2016 to collect randomized controlled trials (RCTs) of Tai Chi for heart failure patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software.ResultsA total of 10 RCTs involving 689 patients were included. The results of meta-analysis showed that, compared with the control group, the heart failure patients in Tai Chi group had better score of minnesotaliving with heart failure questionnaire (MLHFQ) (MD=–9.37, 95%CI –13.09 to –5.65, P<0.000 01), longer six minute walk test (6MWT) (MD=40.37, 95%CI 9.48 to 71.27, P=0.01), higher left ventricular ejectionfractions (LVEF) (MD=7.89, 95%CI 3.01 to 12.77, P=0.002) and lower level of BNP (brain natriuretic peptide) (MD=–10.75, 95%CI –13.20 to –8.30, P<0.000 01); however, as to the maximal oxygen consumption (VO2max) (MD=0.29, 95%CI –1.223 to 1.81, P=0.71), systolic pressure (SBP) (MD=–2.81, 95%CI –8.52 to 2.90, P=0.33) and diastolic pressure (DBP) (MD=0.37, 95%CI –3.73 to 4.48, P=0.86), there were no significant differences between both groups.ConclusionThe current evidence shows that Tai Chi is feasible for patients with heart failure as it has positive effects on life quality, physiological functions. Due to the limited quality and quantity of included studies, the above conclusion should be validated by more high quality studies.
ObjectiveTo systematically review the efficacy of Chinese medicine injection (CMI) for treating heart failure (HF).MethodsCNKI, WanFang Data, VIP, The Cochrane Library, PubMed, and EMbase databases were electronically searched from inception to January 2021 to identify randomized controlled trials (RCTs) on CMI for treating HF. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Network meta-analysis was then performed by RevMan 5.2 software and Stata 16.0 software.ResultsA total of 47 studies were included involving 4 902 patients and 5 types of CMIs, including Shenmai, Shenfu, Yiqi Fumai (lyophilized), Shengmai, and Danhong injections. The results of network meta-analysis showed that the efficacy of combined CMIs was superior to conventional Western medicine alone. For the main efficacy, Shenmai, Shengmai, and Shenfu injections had significant advantages in improving the total clinical effectiveness. Shengmai, Shenmai, and Yiqi Fumai (lyophilized) injections were significantly more effective for reducing NT pro-BNP levels than other injections. Shenfu and Shengmai injections were significantly more effective for reducing BNP levels than other injections. Shenmai, Danhong and Shengmai injections were significantly more effective for improving the left ventricular ejection fraction than the other injections. These CMIs showed similar advantages for secondary efficacy indicators as for main efficacy indicators.ConclusionsThe combined 5 types of CMIs for treating HF can improve the clinical efficacy when compared with conventional Western medicine treatment. Shenmai injection, Yiqi Fumai injection (lyophilized), and Shengmai injection, which is part of Sheng Mai San, have clear advantages in terms of the overall curative effect or on individual indices.
