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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	chronic heart failure vagal nerve stimulation reduced ejection fraction NYHA class 6 min walk distance (6 MWD) Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/bdde0ade878e428ba54473cfa8456276
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spelling	oai:doaj.org-article:bdde0ade878e428ba54473cfa84562762021-11-30T17:59:31ZVagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis2297-055X10.3389/fcvm.2021.766676https://doaj.org/article/bdde0ade878e428ba54473cfa84562762021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.766676/fullhttps://doaj.org/toc/2297-055XObjectives: 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.Lucas Bonacossa Sant'AnnaSérgio Lívio Menezes CouceiroEduardo Amar FerreiraMariana Bonacossa Sant'AnnaPedro Rey CardosoEvandro Tinoco MesquitaGuilherme Mendes Sant'AnnaFernando Mendes Sant'AnnaFernando Mendes Sant'AnnaFrontiers Media S.A.articlechronic heart failurevagal nerve stimulationreduced ejection fractionNYHA class6 min walk distance (6 MWD)Diseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	chronic heart failure vagal nerve stimulation reduced ejection fraction NYHA class 6 min walk distance (6 MWD) Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	chronic heart failure vagal nerve stimulation reduced ejection fraction NYHA class 6 min walk distance (6 MWD) Diseases of the circulatory (Cardiovascular) system RC666-701 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
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.
format	article
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
title	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_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_sort	vagal neuromodulation in chronic heart failure with reduced ejection fraction: a systematic review and meta-analysis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/bdde0ade878e428ba54473cfa8456276
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Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis

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