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Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis

BACKGROUND: The usefulness of lung ultrasound (LUS) in guiding heart failure (HF) treatment is still controversial. PURPOSE: We aimed to evaluate the usefulness of LUS-guided treatment vs. usual care in reducing the major adverse cardiac event (MACE) rate in patients with HF. MATERIALS AND METHODS:...

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Autores principales: Li, Yan, Ai, Hu, Ma, Na, Li, Peng, Ren, Junhong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441745/
https://www.ncbi.nlm.nih.gov/pubmed/36072884
http://dx.doi.org/10.3389/fcvm.2022.943633
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author Li, Yan
Ai, Hu
Ma, Na
Li, Peng
Ren, Junhong
author_facet Li, Yan
Ai, Hu
Ma, Na
Li, Peng
Ren, Junhong
author_sort Li, Yan
collection PubMed
description BACKGROUND: The usefulness of lung ultrasound (LUS) in guiding heart failure (HF) treatment is still controversial. PURPOSE: We aimed to evaluate the usefulness of LUS-guided treatment vs. usual care in reducing the major adverse cardiac event (MACE) rate in patients with HF. MATERIALS AND METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) identified through systematic searches of MEDLINE, EMBASE, the Cochrane Database, Google Scholar, and SinoMed. The primary outcome was MACEs (a composite of all-cause mortality, HF-related rehospitalization, and symptomatic HF). The required information size was calculated by trial sequential analysis (TSA). RESULTS: In total, ten RCTs involving 1,203 patients were included. Overall, after a mean follow-up period of 4.7 months, LUS-guided treatment was associated with a significantly lower risk of MACEs than usual care [relative risk (RR), 0.59; 95% confidence interval (CI), 0.48–0.71]. Moreover, the rate of HF-related rehospitalization (RR, 0.63; 95% CI, 0.40–0.99) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration (standardized mean difference, –2.28; 95% CI, –4.34 to –0.22) were markedly lower in the LUS-guided treatment group. The meta-regression analysis showed a significant correlation between MACEs and the change in B-line count (p < 0.05). The subgroup analysis revealed that the risk of MACEs was markedly lower in patients aged up to 70 years (RR, 0.54; 95% CI, 0.44–0.67), with a lower rate of atrial fibrillation (< 27.2%) (RR, 0.53; 95% CI, 0.43–0.67), and with a lower NT-proBNP concentration (< 3,433 pg/ml) (RR, 0.51; 95% CI, 0.40–0.64). TSA indicated a lower risk of MACEs with LUS-guided treatment than with usual care among patients with HF (p < 0.05). CONCLUSION: Lung ultrasound seems to be a safe and effective method to guide HF treatment. SYSTEMATIC REVIEW REGISTRATION: [https://inplasy.com/], identifier [INPLASY202220124].
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spelling pubmed-94417452022-09-06 Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis Li, Yan Ai, Hu Ma, Na Li, Peng Ren, Junhong Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: The usefulness of lung ultrasound (LUS) in guiding heart failure (HF) treatment is still controversial. PURPOSE: We aimed to evaluate the usefulness of LUS-guided treatment vs. usual care in reducing the major adverse cardiac event (MACE) rate in patients with HF. MATERIALS AND METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) identified through systematic searches of MEDLINE, EMBASE, the Cochrane Database, Google Scholar, and SinoMed. The primary outcome was MACEs (a composite of all-cause mortality, HF-related rehospitalization, and symptomatic HF). The required information size was calculated by trial sequential analysis (TSA). RESULTS: In total, ten RCTs involving 1,203 patients were included. Overall, after a mean follow-up period of 4.7 months, LUS-guided treatment was associated with a significantly lower risk of MACEs than usual care [relative risk (RR), 0.59; 95% confidence interval (CI), 0.48–0.71]. Moreover, the rate of HF-related rehospitalization (RR, 0.63; 95% CI, 0.40–0.99) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration (standardized mean difference, –2.28; 95% CI, –4.34 to –0.22) were markedly lower in the LUS-guided treatment group. The meta-regression analysis showed a significant correlation between MACEs and the change in B-line count (p < 0.05). The subgroup analysis revealed that the risk of MACEs was markedly lower in patients aged up to 70 years (RR, 0.54; 95% CI, 0.44–0.67), with a lower rate of atrial fibrillation (< 27.2%) (RR, 0.53; 95% CI, 0.43–0.67), and with a lower NT-proBNP concentration (< 3,433 pg/ml) (RR, 0.51; 95% CI, 0.40–0.64). TSA indicated a lower risk of MACEs with LUS-guided treatment than with usual care among patients with HF (p < 0.05). CONCLUSION: Lung ultrasound seems to be a safe and effective method to guide HF treatment. SYSTEMATIC REVIEW REGISTRATION: [https://inplasy.com/], identifier [INPLASY202220124]. Frontiers Media S.A. 2022-08-22 /pmc/articles/PMC9441745/ /pubmed/36072884 http://dx.doi.org/10.3389/fcvm.2022.943633 Text en Copyright © 2022 Li, Ai, Ma, Li and Ren. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Li, Yan
Ai, Hu
Ma, Na
Li, Peng
Ren, Junhong
Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis
title Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis
title_full Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis
title_fullStr Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis
title_full_unstemmed Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis
title_short Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis
title_sort lung ultrasound-guided treatment for heart failure: an updated meta-analysis and trial sequential analysis
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441745/
https://www.ncbi.nlm.nih.gov/pubmed/36072884
http://dx.doi.org/10.3389/fcvm.2022.943633
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