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...
Main Authors: | , , , , , , , |
---|---|
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 |