Key result
Left atrium decompression devices significantly improved 6-minute walking distance by 43.95 m, decreased NYHA class by 0.93, and improved health-related quality of life by 20.45 points in patients with heart failure.
Why the study?
Left atrium decompression devices had been investigated in HFpEF, but their efficacy on soft endpoints across the broader spectrum of ejection fraction needed assessment.
Do left atrium decompression devices improve 6-min walking distance, NYHA class, and health-related quality of life in patients with heart failure across the spectrum of ejection fraction?
Meta-Analysis (n=547)
Do left atrium decompression devices improve 6-min walking distance, NYHA class, and health-related quality of life in patients with heart failure across the spectrum of ejection fraction?
Left atrium decompression devices appear safe and significantly improve functional capacity and quality of life in heart failure patients, with greater benefits observed in those with lower ejection fractions.
Supports left atrial decompression for symptom relief in heart failure; extends evidence across ejection fraction spectrum.
BACKGROUND: In patients affected by heart failure (HF) with reduced ejection fraction (HFrEF), pharmacological treatments have been proven to alleviate symptoms and improve prognosis, while no treatment other than sodium-glucose co-transporter-2 inhibitors have demonstrated significant effects in HF with preserved ejection fraction (HFpEF). Left atrium decompression devices (LADd) have been recently investigated as a new interventional approach in patients with HFpEF. OBJECTIVES: To assess the efficacy of LADd on soft endpoints in HF patients across the spectrum of ejection fraction. METHODS: PubMed and Web of Science were searched without restrictions from inception to 28 May 2022 to identify valuable articles. The studies that met the inclusion criteria were analyzed. The prespecified main outcomes were the change from baseline in 6-min walking distance (6MWD), NYHA class and health-related quality of life (HRQoL). Secondary outcomes were reduction in HF hospitalizations, echocardiographic, and hemodynamic parameters. RESULTS: Eleven studies, with a total of 547 patients, were included. LADd significantly improved 6MWD by 43.95 m (95% CI 29.64-58.26 m), decreased NYHA class by 0.93 (95% CI 1.20-0.67), and improved HRQoL questionnaire by 20.45 points (95% CI 13.77-27.14) with better results for all outcomes in patients with lower EFs. CONCLUSION: The present meta-analysis suggests that LADd are favorable in improving 6MWD, NYHA class, and HRQoL in HF across a wide spectrum of ejection fraction, with better outcomes in patients with lower EFs. TRIAL REGISTRATION: CRD42022336077, URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336077 .
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Basile et al. (2023) conducted a meta-analysis in Heart failure (n=547). Left atrium decompression devices (LADd) vs. Pre-procedure baseline was evaluated on Change from baseline in 6-minute walking distance (6MWD) (MD 43.95, 95% CI 29.64-58.26). Left atrium decompression devices significantly improved 6-minute walking distance by 43.95 m, decreased NYHA class by 0.93, and improved health-related quality of life by 20.45 points in patients with heart failure.
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