Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis

Objectives: The aim of this study was to evaluate the effects of invasive vagal nerve stimulation (VNS) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF).Background: Heart failure is characterized by autonomic nervous system imbalance and electrical events that can le...

Full description

Bibliographic Details
Main Authors: Lucas Bonacossa Sant'Anna, Sérgio Lívio Menezes Couceiro, Eduardo Amar Ferreira, Mariana Bonacossa Sant'Anna, Pedro Rey Cardoso, Evandro Tinoco Mesquita, Guilherme Mendes Sant'Anna, Fernando Mendes Sant'Anna
Format: Article
Language:English
Published: Frontiers Media S.A. 2021-11-01
Series:Frontiers in Cardiovascular Medicine
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fcvm.2021.766676/full
_version_ 1819037478728761344
author Lucas Bonacossa Sant'Anna
Sérgio Lívio Menezes Couceiro
Eduardo Amar Ferreira
Mariana Bonacossa Sant'Anna
Pedro Rey Cardoso
Evandro Tinoco Mesquita
Guilherme Mendes Sant'Anna
Fernando Mendes Sant'Anna
Fernando Mendes Sant'Anna
author_facet Lucas Bonacossa Sant'Anna
Sérgio Lívio Menezes Couceiro
Eduardo Amar Ferreira
Mariana Bonacossa Sant'Anna
Pedro Rey Cardoso
Evandro Tinoco Mesquita
Guilherme Mendes Sant'Anna
Fernando Mendes Sant'Anna
Fernando Mendes Sant'Anna
author_sort Lucas Bonacossa Sant'Anna
collection DOAJ
description Objectives: The aim of this study was to evaluate the effects of invasive vagal nerve stimulation (VNS) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF).Background: Heart failure is characterized by autonomic nervous system imbalance and electrical events that can lead to sudden death. The effects of parasympathetic (vagal) stimulation in patients with HF are not well-established.Methods: From May 1994 to July 2020, a systematic review was performed using PubMed, Embase, and Cochrane Library for clinical trials, comparing VNS with medical therapy for the management of chronic HFrEF (EF ≤ 40%). A meta-analysis of several outcomes and adverse effects was completed, and GRADE was used to assess the level of evidence.Results: Four randomized controlled trials (RCT) and three prospective studies, totalizing 1,263 patients were identified; 756 treated with VNS and 507 with medical therapy. RCT data were included in the meta-analysis (fixed-effect distribution). Adverse effects related to VNS were observed in only 11% of patients. VNS was associated with significant improvement (GRADE = High) in the New York Heart Association (NYHA) functional class (OR, 2.72, 95% CI: 2.07–3.57, p < 0.0001), quality of life (MD −14.18, 95% CI: −18.09 to −10.28, p < 0.0001), a 6-min walk test (MD, 55.46, 95% CI: 39.11–71.81, p < 0.0001) and NT-proBNP levels (MD −144.25, 95% CI: −238.31 to −50.18, p = 0.003). There was no difference in mortality (OR, 1.24; 95% CI: 0.82–1.89, p = 0.43).Conclusions: A high grade of evidence demonstrated that vagal nerve stimulation improves NYHA functional class, a 6-min walk test, quality of life, and NT-proBNP levels in patients with chronic HFrEF, with no differences in mortality.
first_indexed 2024-12-21T08:22:04Z
format Article
id doaj.art-bdde0ade878e428ba54473cfa8456276
institution Directory Open Access Journal
issn 2297-055X
language English
last_indexed 2024-12-21T08:22:04Z
publishDate 2021-11-01
publisher Frontiers Media S.A.
record_format Article
series Frontiers in Cardiovascular Medicine
spelling doaj.art-bdde0ade878e428ba54473cfa84562762022-12-21T19:10:25ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-11-01810.3389/fcvm.2021.766676766676Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-AnalysisLucas Bonacossa Sant'Anna0Sérgio Lívio Menezes Couceiro1Eduardo Amar Ferreira2Mariana Bonacossa Sant'Anna3Pedro Rey Cardoso4Evandro Tinoco Mesquita5Guilherme Mendes Sant'Anna6Fernando Mendes Sant'Anna7Fernando Mendes Sant'Anna8Medical School, Department of Education and Graduation, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, BrazilHospital Santa Izabel, Rio de Janeiro, BrazilMedical School, Department of Education and Graduation, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, BrazilMedical School, Department of Education and Graduation, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, BrazilMedical School, Department of Education and Graduation, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, BrazilDepartment of Cardiology, Universidade Federal Fluminense, Niterói, BrazilNeonatal Division, McGill University Health Center, Montreal, QC, CanadaHospital Santa Izabel, Rio de Janeiro, BrazilDepartment of Education and Graduation, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilObjectives: The aim of this study was to evaluate the effects of invasive vagal nerve stimulation (VNS) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF).Background: Heart failure is characterized by autonomic nervous system imbalance and electrical events that can lead to sudden death. The effects of parasympathetic (vagal) stimulation in patients with HF are not well-established.Methods: From May 1994 to July 2020, a systematic review was performed using PubMed, Embase, and Cochrane Library for clinical trials, comparing VNS with medical therapy for the management of chronic HFrEF (EF ≤ 40%). A meta-analysis of several outcomes and adverse effects was completed, and GRADE was used to assess the level of evidence.Results: Four randomized controlled trials (RCT) and three prospective studies, totalizing 1,263 patients were identified; 756 treated with VNS and 507 with medical therapy. RCT data were included in the meta-analysis (fixed-effect distribution). Adverse effects related to VNS were observed in only 11% of patients. VNS was associated with significant improvement (GRADE = High) in the New York Heart Association (NYHA) functional class (OR, 2.72, 95% CI: 2.07–3.57, p < 0.0001), quality of life (MD −14.18, 95% CI: −18.09 to −10.28, p < 0.0001), a 6-min walk test (MD, 55.46, 95% CI: 39.11–71.81, p < 0.0001) and NT-proBNP levels (MD −144.25, 95% CI: −238.31 to −50.18, p = 0.003). There was no difference in mortality (OR, 1.24; 95% CI: 0.82–1.89, p = 0.43).Conclusions: A high grade of evidence demonstrated that vagal nerve stimulation improves NYHA functional class, a 6-min walk test, quality of life, and NT-proBNP levels in patients with chronic HFrEF, with no differences in mortality.https://www.frontiersin.org/articles/10.3389/fcvm.2021.766676/fullchronic heart failurevagal nerve stimulationreduced ejection fractionNYHA class6 min walk distance (6 MWD)
spellingShingle Lucas Bonacossa Sant'Anna
Sérgio Lívio Menezes Couceiro
Eduardo Amar Ferreira
Mariana Bonacossa Sant'Anna
Pedro Rey Cardoso
Evandro Tinoco Mesquita
Guilherme Mendes Sant'Anna
Fernando Mendes Sant'Anna
Fernando Mendes Sant'Anna
Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
Frontiers in Cardiovascular Medicine
chronic heart failure
vagal nerve stimulation
reduced ejection fraction
NYHA class
6 min walk distance (6 MWD)
title Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_full Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_fullStr Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_full_unstemmed Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_short Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_sort vagal neuromodulation in chronic heart failure with reduced ejection fraction a systematic review and meta analysis
topic chronic heart failure
vagal nerve stimulation
reduced ejection fraction
NYHA class
6 min walk distance (6 MWD)
url https://www.frontiersin.org/articles/10.3389/fcvm.2021.766676/full
work_keys_str_mv AT lucasbonacossasantanna vagalneuromodulationinchronicheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysis
AT sergioliviomenezescouceiro vagalneuromodulationinchronicheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysis
AT eduardoamarferreira vagalneuromodulationinchronicheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysis
AT marianabonacossasantanna vagalneuromodulationinchronicheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysis
AT pedroreycardoso vagalneuromodulationinchronicheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysis
AT evandrotinocomesquita vagalneuromodulationinchronicheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysis
AT guilhermemendessantanna vagalneuromodulationinchronicheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysis
AT fernandomendessantanna vagalneuromodulationinchronicheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysis
AT fernandomendessantanna vagalneuromodulationinchronicheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysis