Objective To analyze comprehensively the data of randomized controlled trials(RCT)and non-randomized controlled trials for assessing the efficacy of transcatheter atrial shunt on chronic heart failure(CHF)through systematic review and Meta-analysis.Methods The databases of PudMed,Cochrane Library,EMBase,CNKI,WanFang Data,VIP and CBM were retrieved from database establishment time to Oct.2022 to collect RCT published on treatment of chronic heart failure(CHF)with transcatheter atrial shunt,and to intake relevant literature according to inclusioncriteria.The data was screened,extracted and reviewed on biasrisk by 2 researchers independently and given a Meta-analysis by using RevMan5.4 software.Results A total of 7 articles were intaken,including 2 RCT(670 patients)and 5 non-randomized controlled trials(178 patients).There were 509 patients with successful implantation oftranscatheter atrial shunt.The results of Meta-analysis showed thattranscatheter atrial shunt raised significantly 6-minute walk distance 6MWD,(MD=24.01,95％CI:-2.74～50.76,P=0.08),reduced level of N-terminal pro-brain natriuretic peptide NT-proBNP,(MD=-7.63,95％CI:-306.91～291.66,P=0.96),and reduced pulmonary capillary wedge pressure PCWP,(MD=-2.88,95％CI:-3.93～-1.83,P=0.50)and mean pulmonary arterial pressure mPAP,(MD=-1.32,95％CI:-3.31～0.67,P=0.88).The level of left ventricular ejection fraction(LVEF)increased significantly(MD=3.16,95％CI:0.80～5.52,P=0.89),left atrial volume index(LAVI)decreased significantly(MD=-3.15,95％CI:-7.92～1.61,P=0.19),and tricuspid annular plane systolic excursion(TAPSE)was stable during follow-up period.The scores of Kansas City Cardiomyopathy Questionnaire(KCCQ)and Minnesota Living with Heart Failure Questionnaire(MLHFQ)were improved KCCQ:(MD=-11.52,95％CI:-45.68～22.64,P＜0.01);MLFHQ:(MD=-20.21,95％CI:-32.8～-7.56,P=0.04).However,the risk of severe adverse events related to treatment was higher(RR=5.58,95％CI:2.97～10.50,P＜0.01),and risk of all-cause death increased too early all-cause death risk:(RR=5.00,95％CI:0.61～41.05,P=0.13);all-causemortality:(RR=10.20,95％CI:2.84,36.64,P=0.0004).Conclusion Transcatheter atrial shunt has significant curative effect in treatment of heart failure with preserved ejection fraction.
维普
万方数据