■本研究旨在系统地评估肾脏去神经(RDN)在治疗射血分数降低的心力衰竭(HFrEF)中的有效性和安全性。
■在多个数据库中进行了全面搜索:CochraneLibrary,PubMed,Embase,WebofScience,中国国家知识基础设施(CNKI),万方数据,和中国科技期刊VIP数据库。收集了所有研究RDN治疗HFrEF至2024年3月15日的临床试验。使用Cochrane风险评估工具评估纳入研究的质量。收集了相关数据,使用ReviewManager5.3进行荟萃分析,同时进行敏感性分析和发表偏倚分析.
■应用纳入和排除标准后,选择8项随机对照试验(RCT)进行分析,包括314名患者;154名患者在住院期间接受了RDN治疗,150例随机分为对照组,接受药物治疗。荟萃分析表明,与药物治疗相比,RDN导致左心室射血分数(LVEF)增加9.59%;左心室射血分数(LVEF)增加(95%CI:7.92-11.27,Z=11.20,p<0.01);心钠素(BNP)降低(95%CI:-364.19-191.75,Z=6.32,p<0.01;N-末端B型心钠素降低1.59%,n-95%Z降低,n-n-n=各组间左心室收缩末期内径(LVESD)和收缩压/舒张压(OSBP/ODBP)相似(p>0.01)。作为安全指标,RDN组估计肾小球滤过率(eGFR)提高了7.11[ml/(min·1.73m2)](95%CI:1.10-13.12,Z=2.32,p<0.05)。LVEF,BNP,6MWT,LVEDD,LAD和eGFR使用固定效应模型进行荟萃分析,其他指标是随机效应模型。
■RDN显著改善了HFrEF患者的心功能,同时表现出良好的安全性。
UNASSIGNED: This study aimed to systematically evaluate the effectiveness and safety of renal
denervation (RDN) in managing heart failure with reduced ejection fraction (HFrEF).
UNASSIGNED: A comprehensive search was done in multiple databases: Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database for Chinese Technical Periodicals. All clinical trials investigating RDN treatment for HFrEF through 15 March 2024 were gathered. The quality of the included studies was evaluated utilizing the Cochrane risk assessment tool. The pertinent data were gathered, and a meta-analysis was done using Review Manager 5.3, accompanied by sensitivity and publication bias analyses.
UNASSIGNED: After applying the inclusion and exclusion criteria, eight randomized controlled trials (RCTs) were selected for analysis, encompassing 314 patients; 154 patients underwent RDN treatment during hospitalization, while 150 were randomized to the control group to receive medication therapy. The meta-analysis demonstrated that compared to medication therapy, RDN contributed to a 9.59% increase in left ventricular ejection fraction (LVEF) (95% CI: 7.92-11.27, Z = 11.20, p < 0.01); a decrease in brain natriuretic peptide (BNP) (95% CI: -364.19--191.75, Z = 6.32, p < 0.01); a decrease in N-terminal pro B-type natriuretic peptide (NT-proBNP) (95% CI: -1300.15--280.95, Z = 3.04, p < 0.01); a decrease in the New York Heart Association (NYHA) classification (95% CI: -1.58--0.34, Z = 3.05, p < 0.01); a 90.00-m increase in 6-min walk test (6MWT) (95% CI: 68.24-111.76, Z = 8.11, p < 0.01); a reduction of 4.05 mm in left ventricular end-diastolic diameter (LVEDD) (95% CI: -5.65--2.48, Z = 5.05, p < 0.01); a decrease of 4.60 heart beats·min-1 (95% CI: -8.83--0.38, Z = 2.14, p < 0.05); and a 4.67-mm reduction in left atrial diameter (LAD) (95% CI: -6.40--2.93, Z = 5.27, p < 0.01). Left ventricular end-systolic diameter (LVESD) and systolic/diastolic blood pressure (OSBP/ODBP) were similar between groups (p > 0.01). As the safety indicator, estimated glomerular filtration rate (eGFR) improved by 7.11 in the RDN group [ml/(min·1.73 m2)] (95% CI: 1.10-13.12, Z = 2.32, p < 0.05). LVEF, BNP, 6MWT, LVEDD, LAD and eGFR were meta-analyzed using a fixed-effects model, the other indicators a random-effects model.
UNASSIGNED: RDN significantly ameliorated cardiac function in HFrEF patients while exhibiting commendable safety.