PMID- 34901227
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211215
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 8
DP  - 2021
TI  - Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A 
      Systematic Review and Meta-Analysis.
PG  - 766676
LID - 10.3389/fcvm.2021.766676 [doi]
LID - 766676
AB  - 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.
CI  - Copyright (c) 2021 Sant'Anna, Couceiro, Ferreira, Sant'Anna, Cardoso, Mesquita, 
      Sant'Anna and Sant'Anna.
FAU - Sant'Anna, Lucas Bonacossa
AU  - Sant'Anna LB
AD  - Medical School, Department of Education and Graduation, Fundacao 
      Tecnico-Educacional Souza Marques, Rio de Janeiro, Brazil.
FAU - Couceiro, Sergio Livio Menezes
AU  - Couceiro SLM
AD  - Hospital Santa Izabel, Rio de Janeiro, Brazil.
FAU - Ferreira, Eduardo Amar
AU  - Ferreira EA
AD  - Medical School, Department of Education and Graduation, Fundacao 
      Tecnico-Educacional Souza Marques, Rio de Janeiro, Brazil.
FAU - Sant'Anna, Mariana Bonacossa
AU  - Sant'Anna MB
AD  - Medical School, Department of Education and Graduation, Fundacao 
      Tecnico-Educacional Souza Marques, Rio de Janeiro, Brazil.
FAU - Cardoso, Pedro Rey
AU  - Cardoso PR
AD  - Medical School, Department of Education and Graduation, Fundacao 
      Tecnico-Educacional Souza Marques, Rio de Janeiro, Brazil.
FAU - Mesquita, Evandro Tinoco
AU  - Mesquita ET
AD  - Department of Cardiology, Universidade Federal Fluminense, Niteroi, Brazil.
FAU - Sant'Anna, Guilherme Mendes
AU  - Sant'Anna GM
AD  - Neonatal Division, McGill University Health Center, Montreal, QC, Canada.
FAU - Sant'Anna, Fernando Mendes
AU  - Sant'Anna FM
AD  - Hospital Santa Izabel, Rio de Janeiro, Brazil.
AD  - Department of Education and Graduation, Universidade Federal do Rio de Janeiro, 
      Rio de Janeiro, Brazil.
LA  - eng
PT  - Systematic Review
DEP - 20211124
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC8652049
OTO - NOTNLM
OT  - 6 min walk distance (6 MWD)
OT  - NYHA class
OT  - chronic heart failure
OT  - reduced ejection fraction
OT  - vagal nerve stimulation
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/12/14 06:00
MHDA- 2021/12/14 06:01
PMCR- 2021/01/01
CRDT- 2021/12/13 18:10
PHST- 2021/08/29 00:00 [received]
PHST- 2021/10/04 00:00 [accepted]
PHST- 2021/12/13 18:10 [entrez]
PHST- 2021/12/14 06:00 [pubmed]
PHST- 2021/12/14 06:01 [medline]
PHST- 2021/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2021.766676 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2021 Nov 24;8:766676. doi: 10.3389/fcvm.2021.766676. 
      eCollection 2021.