Title:Improvement of Hemodynamics and Quality of Life Before and After Interatrial Shunt Devices Implantation for Chronic Heart Failure: A Systematic Review and Meta-analysis
Volume: 22
Issue: 1
Author(s): Yugen Guan, Lei Yang, Yuwen Lu, Xiaogan Liang, Ruiqi Wang, Rongrong Shen, Liang Yang, Jingwen Song, Shaofei Liu, Yuan Bai, Zhifu Guo and Ni Zhu*
Affiliation:
- Department of Cardiology, Changhai Hospital Affiliated to Naval Medical University, Shanghai 200433, China
Keywords:
Heart failure, interatrial shunt devices, hemodynamics, pulmonary capillary wedge pressure, cardiac devices, dyspnea.
Abstract:
Introduction: The objective of this study was to compare the quality of life and hemodynamic
changes before and after transcatheter atrial septal shunt implantation.
Methods: A systematic search was conducted in the Cochrane Library, PubMed, and Embase
from inception to September 2023 for studies reporting on hemodynamics or quality of life in
patients with chronic heart failure after atrial septal shunt implantation. A meta-analysis was performed,
in which a total of 1026 participants from 13 articles were included.
Results and Discussion: Following the implantation, pulmonary capillary wedge pressure
(PCWP) decreased by 2.60 mmHg. Right atrial pressure (RAP) increased by 1.30 mmHg and left
ventricular ejection fraction (LVEF) increased by 2.13%. However, there were no significant differences
in cardiac output and mean pulmonary artery pressure (mPAP) after operation. Minnesota
Living with Heart Failure (MLWHF) Score decreased by -19.28, while the Kansas City
Cardiomyopathy Questionnaire (KCCQ) score increased by 25.41. Moreover, 6-minute walking
distance (6MWD) increased by 32.22 m. The results of subgroup analysis showed that for patients
with heart failure with preserved ejection fraction (HFpEF) and heart failure with mildly
reduced ejection fraction (HFmrEF), LVEF increased by 3.09% while CO increased by 1.01
L/min after operation. Meanwhile, PCWP significantly decreased by 2.67 mmHg and MLWHF
scores decreased by 19.28. Additionally, 6MWD significantly increased by 27.5 m. However,
there were no significant changes in RAP and mPAP after operation. For patients with heart failure
with reduced ejection fraction (HFrEF), interatrial shunt device implantation did not achieve
a significant increase in LVEF.
Conclusion: These findings suggest that while atrial septal shunt implantation might not yield
LVEF elevation among patients with HFrEF, it improves hemodynamic parameters, exercise endurance,
and QoL among individuals with HFpEF/HFmrEF.
