Evaluating the Efficacy of Interatrial Shunt Devices in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis.

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a prevalent and challenging condition with limited therapeutic options. This meta-analysis aims to assess the feasibility and effectiveness of interatrial shunt devices (IASD) in the treatment of HFpEF, focusing on key hemodynamic parameters and clinical outcomes. Six clinical trials, encompassing 324 patients, were included in this analysis. The results showed a significant reduction in pulmonary capillary wedge pressure (PCWP) at rest after IASD implantation, with a mean difference of 1.55 mm Hg. PCWP during exercise also exhibited a decrease, indicating improved exercise tolerance. However, there was an increase in mean right atrial pressure following IASD implantation. These findings suggest that IASD implementation can effectively lower left atrial pressure, a critical target in HFpEF management. This results in substantial clinical improvements, including enhanced New York Heart Association class, quality of life, and 6-minute walk distance. Echocardiographic assessments revealed a reduction in left ventricular end-diastolic volume index and stable right ventricular changes. The meta-analysis underscores the potential benefits of IASD in ameliorating the symptoms and clinical outcomes of HFpEF patients. The increase in mean right atrial pressure warrants further investigation into its effects on right heart function. Additionally, this analysis emphasizes the need for larger, randomized clinical trials to validate these findings and determine optimal patient selection criteria. IASD implantation holds promise as a therapeutic option for HFpEF, offering the potential to improve the quality of life and functional status of affected patients. However, further research is imperative to confirm its efficacy relative to existing treatments and to address concerns regarding its impact on right heart function. This meta-analysis contributes to a deeper understanding of IASD's role in HFpEF management.