Meta-analysis Of Prospective Trials Research Articles

Abstract 4138611: Impact of SGLT-2 Inhibitor Use on Atrial Fibrillation Incidence Following Heart Failure Hospitalization

Introduction: The development of atrial fibrillation (AF) in patients with heart failure (HF) is associated with increased morbidity and mortality. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have demonstrated cardiovascular benefit in patients with both preserved and reduced ejection fractions. Meta analysis of prospective trials suggest reduced incidence and burden of atrial fibrillation in patients taking SGLT-2 inhibitors, though this has not been specifically addressed in prospective trials. Hypothesis: SGLT-2 inhibitors reduce the incidence of atrial fibrillation in patients with heart failure. Aim: The goal of the study is to assess the impact of SGLT-2 inhibitor on the incidence of atrial fibrillation following heart failure hospitalization. Methods: The study included consecutive patients who were admitted to an academic tertiary care center over a 3 year time period with a primary diagnosis of heart failure exacerbation and no prior diagnosis of AF. The primary outcome was development of AF within 12 months after hospitalization. Demographic, comorbidity, echocardiographic data, and medications were obtained. Cox-regression analysis was performed to identify the predictors of new-onset AF after HF hospitalization. Results: Among the 3,953 patients included in our study, 704 (17.8%) patients were prescribed SGLT-2 inhibitors. Of those taking SGLT-2 inhibitors, 559 (79.4%) patients had diabetes. SGLT-2 inhibitor use is associated with significant reduction of AF at one year ( p<0.001; RR 0.65; 95% CI: 0.51-.81 ). This finding was consistent across patients with reduced ejection fractions (EF<50%) ( p=0.001; RR 0.56; 95% CI: 0.40-.80 ) and preserved ejection fraction (EF>50%)( p=0.001; RR 0.58; 95% CI: 0.42-0.80 ). Conclusion: In patients with reduced ejection fraction and preserved ejection fraction heart failure, use of an SGLT-2 inhibitor is associated with a statistically significant lower risk of new-onset atrial fibrillation at one year following HF hospitalization.

Abstract 4138604: Impact of GLP-1 Agonist on the Incidence of Atrial Fibrillation in Obese Patients Following Heart Failure Hospitalization

Introduction: Atrial fibrillation (AF) in patients with heart failure (HF) is associated with increased morbidity and mortality. Glucagon-like peptide-1 (GLP-1) agonists have been shown to reduce cardiovascular risk in patients with obesity and diabetes, respectively. Meta-analysis of prospective trials looking at GLP-1 agonist use on the incidence of AF suggest benefit in patients with diabetes but is of unclear benefit in this regard for patients with obesity. Hypothesis: GLP-1 agonists reduce atrial fibrillation incidence in patients with diabetes and obesity. Aims: The goal of the study is to assess the effects of GLP-1 agonist on incidence of new AF in patients with obesity and diabetes following heart failure hospitalization. Methods: The study included consecutive patients who were admitted to an academic tertiary care center over three years with a primary diagnosis of heart failure exacerbation and no prior diagnosis of AF. The primary outcome was incidence of AF within 12 months after hospitalization. Demographic, comorbidity, echocardiography, and medications were obtained. Cox-regression analysis was performed to identify the predictors of new-onset AF following HF hospitalization. Results: Of the patients included in our study, 1668 (42.9%) have a BMI greater than or equal to 30, 574 (14.5%) have BMI greater than or equal to 40, and 2300 (58.2%) have diabetes mellitus. GLP-1 use is associated with a significantly lower incidence of AF at one year in obese patients (p=0.042; RR 0.73; 95% CI: 0.54-.99) (Figure), while in non-obese individuals, GLP-1 receptor agonist was not associated with a decreased incidence of AF (p=0.674; RR 1.08; 95% CI: 0.76-1.53). In patients with diabetes, GLP-1 receptor agonist use did not reach statistical significance for reduced AF incidence following heart failure hospitalization ( p=0.091; RR 0.80; 95% CI 0.62-1.04 ). Conclusion: GLP-1 receptor agonist use is associated with a statistically significant reduction of incidence of new atrial fibrillation at one year following hospitalization for heart failure in obese patients.

PD-L1 expression as a potential predictor of immune checkpoint inhibitor efficacy and survival in patients with recurrent or metastatic nasopharyngeal cancer: a systematic review and meta-analysis of prospective trials.

The predictive value of programmed death-ligand 1 (PD-L1) expression in nasopharyngeal cancer (NPC) patients receiving immune checkpoint inhibitors (ICIs) remains controversial. This study aimed to evaluate the optimal threshold of PD-L1 expression in predicting the efficacy of ICIs in patients with recurrent or metastatic (R/M) NPC. A meta-analysis was performed by retrieving relevant literature from PubMed, EMBASE, and Cochrane Library databases. Data on the pooled risk ratio (RR), mean overall survival (OS), progression-free survival (PFS), overall response rate (ORR) with 95% confidence interval, and 1%, 10%, and 25% PD-L1 expression cutoff points were obtained to examine the role of PD-L1 as a biomarker in R/M NPC patients receiving immunotherapy. In total, 1,312 patients from 14 studies were included. An improvement in PFS was observed in both patients with PD-L1 ≥ 1% (RR = 0.76, 95% CI 0.62-0.92, P = 0.005) and those with PD-L1 < 1% (RR = 0.68, 95% CI: 0.35-1.32, P = 0.26) who received first-line treatment with immunotherapy, with no significant difference between these subgroups. The pooled ORR was significantly higher in patients with PD-L1 ≥ 1% (ORR = 0.37) than in those with PD-L1 < 1% (ORR = 0.22) (P < 0.01) undergoing subsequent-line treatment. However, when we used the PD-L1 cutoff values of 10% and 25%, there was no significant difference between the positive (PD-L1 expression ≥ the cutoff value) and negative (PD-L1 expression < the cutoff value) subgroups. PD-L1 ≥ 1% also tended to be associated with better PFS and OS. Our meta-analysis suggested that first-line immunotherapy could significantly improve PFS in R/M NPC patients, regardless of the PD-L1 expression levels. Positive PD-L1 expression (≥ 1%) might be a potential predictive biomarker for a better overall response to immunotherapy in R/M NPC patients in subsequent-line setting. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024495841 PROSPERO, identifier CRD42024495841.

Radial endobronchial ultrasound - guided bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis of prospective trials

BackgroundThe diagnostic yield of radial endobronchial ultrasound (r-EBUS) for the diagnosis of peripheral pulmonary lesions (PPLs) varies between studies and is affected by multiple factors. We aimed to evaluate the efficacy and safety of r-EBUS, and to explore the factors influencing the diagnostic yield of r-EBUS in patients with PPLs. MethodsThe PubMed, Web of Science, and EMBASE databases were searched to identify relevant studies that used r-EBUS for diagnosing PPLs from the date of inception to Dec 2022. Meta-analysis was conducted using Review Manager 5.4 and Stata 15.1. ResultsAn analysis of 46 studies with a total of 7252 PPLs was performed. The pooled diagnostic yield of r-EBUS was 73.4 % (95 % CI: 69.9%–76.7 %), with significant heterogeneity detected among studies (I2 = 90 %, P < 0.001). Further analysis demonstrated PPLs located in the middle or lower lobe, >2 cm in size, malignant in type, solid in appearance on computerized tomography (CT), present in bronchus sign, the within probe location, and the addition of rapid on-site evaluation (ROSE) were associated with increased diagnostic yield, whereas use of a guide sheath (GS), bronchoscopy type, and a multimodality approach failed to influence the outcome. The pooled incidence rates of overall complications, pneumothorax and moderate and severe bleeding were 3.1 % (95 % CI: 2.1%–4.3 %), 0.4 % (95 % CI: 0.1%–0.7 %) and 1.1 % (95 % CI: 0.5%–2.0 %), respectively. Conclusionsr-EBUS has an appreciable diagnostic yield and an excellent safety manifestation when used to deal with PPLs.

Speckle-tracking echocardiography for predicting improvement of myocardial contractile function after revascularization: a meta-analysis of prospective trials

Some studies have indicated that the use of 2D-Speckle tracking echocardiography (2DSTE) aids in predicting recovery of myocardial contractile function after revascularization in patients with chronic ischemic left ventricular (LV) dysfunction or acute myocardial infarction (MI). The purpose of this meta-analysis was to evaluate the diagnostic accuracy of 2DSTE strain in the detection of myocardial viability at rest and during low-dose dobutamine (LDD) stress. A systematic review for all prospective trials using 2DSTE to assess myocardial viability until January 2019 was done. Using a standard approach of meta-analysis for diagnostic tests. Overall, nine studies including 525 patients with either chronic ischemic heart disease or acute MI fulfilled the inclusion criteria. Seven studies used longitudinal strain (LS) at rest, nine studies used circumferential strain (CS) at rest, four studies used LS during LDD stress, and four studies used CS during LDD stress. LS and CS during LDD stress showed equally high sensitivity (81.5% and 81.5% respectively) and specificity (81.3% and 81.4% respectively) for detecting reversible dysfunction. At rest, LS and CS showed equally lower sensitivity (67.1%, p < 0.0001 vs. LDD stress and 68.7%, p < 0.0001, vs. LDD stress, respectively) and specificity (64%, p < 0.0001 vs. LDD stress and 65.7%, p = 0.0008 vs. LDD stress, respectively) as compared with LDD stress. LS and CS by 2DSTE during LDD stress accurately identify reversible ischemic myocardial dysfunction in patients with chronic ischemic LV dysfunction or after MI. The use of LDD stress can be recommended over resting strain measures in this setting.

Surgical resection rates after neoadjuvant therapy for localized pancreatic ductal adenocarcinoma: meta-analysis.

Neoadjuvant therapy is increasingly being used before surgery for localized pancreatic cancer. Given the importance of completing multimodal therapy, the aim of this study was to characterize surgical resection rates after neoadjuvant therapy as well as the reasons for, and long-term prognostic impact of, not undergoing resection. A systematic review and meta-analysis of prospective trials and high-quality retrospective studies since 2010 was performed to calculate pooled resection rates using a generalized random-effects model for potentially resectable, borderline resectable, and locally advanced pancreatic cancer. Median survival times were calculated using random-effects models for patients who did and did not undergo resection. In 125 studies that met the inclusion criteria, neoadjuvant therapy consisted of chemotherapy (36.8 per cent), chemoradiation (15.2 per cent), or chemotherapy and radiation (48.0 per cent). Among 11 713 patients, the pooled resection rates were 77.4 (95 per cent c.i. 71.3 to 82.5), 60.6 (54.8 to 66.1), and 22.2 (16.7 to 29.0) per cent for potentially resectable, borderline resectable, and locally advanced pancreatic cancer respectively. The most common reasons for not undergoing resection were distant progression for resectable and borderline resectable cancers, and local unresectability for locally advanced disease. Among 42 studies with survival data available, achieving surgical resection after neoadjuvant therapy was associated with improved survival for patients with potentially resectable (median 38.5 versus 13.3 months), borderline resectable (32.3 versus 13.9 months), and locally advanced (30.0 versus 14.6 months) pancreatic cancer (P < 0.001 for all). Although rates of surgical resection after neoadjuvant therapy vary based on anatomical stage, surgery is associated with improved survival for all patients with localized pancreatic cancer. These pooled resection and survival rates may inform patient-provider decision-making and serve as important benchmarks for future prospective trials.

Efficacy and safety of EGFR inhibitors and radiotherapy in locally advanced non-small-cell lung cancer: a meta-analysis.

Aim: To assess the efficacy and safety of EGFR inhibitors combined with (chemo)radiotherapy in unresectable, locally advanced non-small-cell lung cancer. Materials & methods: A systematic review and meta-analysis of prospective trials was performed. Results: Twenty-eight studies of 1640 patients were included. In patients harboring EGFR-sensitive mutations, the pooled objective response rate, 1-year overall survival rate and 1-year progression-free survival rate of EGFR-TKIs+ (chemo)radiotherapy were 0.803, 0.766 and 0.554, respectively. Compared with chemoradiotherapy, the addition of EGFR inhibitors did not significantly increase the risk of grade ≥3 pneumonitis and esophagitis. Conclusion: EGFR-tyrosine kinase inhibitors combined with (chemo)radiotherapy are tolerable and the clinical benefit is promising, especially in patients with EGFR-sensitive mutations.

Abstract P4-07-08: Prognostic value of intrinsic subtypes (IS) in hormone receptor-positive (HoR+) metastatic breast cancer (MBC): A systematic review and meta-analysis of prospective trials

Abstract Background: HoR+ breast cancer (BC) is an heterogeneous disease, comprising 4 molecular subtypes (i.e.Luminal A [LumA], Luminal B [LumB]), HER2-Enriched [HER2E] and Basal-like [BL]). In HoR+ MBC, non-LumA subtypes appear to be associated with poorer survival outcome compared to LumA. Here, we present a meta-analysis to validate the prognostic value of IS inHoR+ MBC. Methods: We performed a systematic review and trial-level meta-analysis of all available prospective phase II/III trials in HoR+ MBC where the prognostic role of the IS was assessed in terms of progression-free survival (PFS) or time-to-progression (TTP), if the former was not available. Hazard ratios (HR) and 95% confidence intervals (CI) had to be available or computable. Subgroup analyses according to treatment, menopausal and HER2 status were also performed. The random-effect model of Der Simonian and Laird was applied. Heterogeneity was assessed through Cochran’s Q and I2. Funnel plot with Egger’s and Begg’s test for publication bias, multiple sensitivity analyses and risk of bias analysis were also conducted. Revman 5.4 and R 3.6.1 for MacOS X were used for statistical analyses. Tests were two-sided and the threshold for significance was set at p&amp;lt;0.05. Results: Overall, 360 records were screened from Pubmed and the Cochrane CENTRAL. Six randomized phase III trials of either endocrine therapy (ET)±target therapy (TT) or chemotherapy (only 1 study) and 1 single arm phase II trial of ET+TT were included, for a total of 2,536 patients (pts). 1,401 (55.2%) pts presented with non-LumA BC and 1,135(44.8%) presented with LumA BC. Within non-LumA BC, 574 (50.0%) were LumB, 280 (20.0%) HER2E and 62 (4.4%) BL. Compared to LumA, non-LumA tumors were associated with worse PFS/TTP (HR: 1.77, 95% CI: 1.54 - 2.05, p&amp;lt;0.001), independently of HER2 (HER2+ vs. HER2-negative, psubgroup difference[psub]=0.16), systemic treatment (ET vs. ET+TT vs. CT, psub=0.96) and menopausal status (pre vs. post, psub=0.12). Compared to LumA, each IS showed a statistically significant poorer outcome (psub=0.01), with LumB (HR: 1.46, 1.21 -. 1.77) showing a better prognostic effect than HER2E (HR: 2.39, 1.78 - 3.21) and BL (HR:2.67, 1.61 - 4.43). Heterogeneity was moderate (I2=61%, pheterogeneity[pH]&amp;lt;0.001). Sensitivity analyses confirmed the robustness of the main result, which did not significantly vary by removing the most influential cases sequentially or concomitantly. No publication bias was observed (Egger’s p=0.492; Begg’s p=0.719) and risk of bias analysis did not raise concerns regarding studies’ internal validity. Conclusions: Compared to LumA, the other subtypes are consistently associated with poorer survival outcome in HoR+ MBC, independently of HER2, treatment and menopausal status. Future trial designs in HoR+ MBC should consider this biological heterogeneity. Table 1.Included studies characteristicsStudy ReferenceTrial NameBreast CancerSubgroupMenopausal StatusTrial TypeTreatmentNon-Luminal ALuminal APrat A. et al. The Oncologist 2019BOLERO2HR+/HER2-negPostmenopausalRandomizedEverolimus+exemestane vs exemestane139122Jørgensen C.L.T. et al. Acta Oncologica 2014DBCGMainly HR+/HER2-negMixedRandomizedDocetaxel+gemcitabine vs docetaxel18684Prat A. et al. JAMA Oncol 2016EGF30008HR+/HER2+ and negPostmenopausalRandomizedLetrozole+lapatinib vs letrozole424377Prat A. et al. J Clin Oncol 2021MONALEESA 2HR+/HER2-negPostmenopausalRandomizedRibociclib+letrozole vs letrozole--Prat A. et al. J Clin Oncol 2021MONALEESA 3HR+/HER2-negPostmenopausalRandomizedRibociclib+fulvestrant vs fulvestrant618542Prat A. et al. J Clin Oncol 2021MONALEESA 7HR+/HER2-negPremenopausalRandomizedRibociclib+AI/TAM vs AI/TAM--Ciruelos E. et al. Clin Can Res 2020PATRICIAHR+/HER2+PostmenopausalNon-RandomizedPalbociclib+/-letrozole+trastuzumab3410 Citation Format: Francesco Schettini, Olga Martínez-Sáez, Nuria Chic, Fara Brasó-Maristany, Patricia Galván, Debora Martínez, Laia Paré, Maria Vidal, Barbara Adamo, Montserrat Muñoz, Tomás Pascual, Eva Ciruelos, Charles M Perou, Lisa A Carey, Aleix Prat. Prognostic value of intrinsic subtypes (IS) in hormone receptor-positive (HoR+) metastatic breast cancer (MBC): A systematic review and meta-analysis of prospective trials [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-07-08.

A Systematic Review and Meta-Analysis of Pancreatectomy Rates Following Neoadjuvant Therapy in Patients with Pancreatic Ductal Adenocarcinoma

Introduction: Neoadjuvant therapy (NT) is increasingly used prior to surgery for localized pancreatic ductal adenocarcinoma (PDAC). Given the importance of completing multimodality therapy, we sought to characterize rates and reasons for failing to undergo pancreatectomy following contemporary NT. Methods: A systematic review and meta-analysis of prospective trials and intention-to-treat retrospective studies since 2010 was performed to summarize rates of NT completion, surgical exploration, overall resection, and R0 resectionfollowing neoadjuvant chemotherapy and/or chemoradiation for potentially resectable (PR), borderline resectable (BR) and locally advanced (LA) disease. Pooled results were calculated using mixed effect models with restricted maximum likelihood estimation. Results: Of 117 studies that met inclusion criteria, 15 were randomized controlled trials, 62 nonrandomized prospective studies, and 40 retrospective cohort studies. NT consisted of chemotherapy alone (35.0%), chemoradiation alone (10.3%), or chemotherapy and radiation (54.7%). Among 11,147 patients, the pooled overall resection rates were 76.9%, 59.5%, and 30.0% for PR, BR, and LA PDAC, respectively. Rates of NT completion, exploration, and R0 resection rates (Figure 1a) and reasons for failing to undergo resection (Figure 1b) varied based on anatomic stage. Conclusion: In this meta-analysis of intention-to-treat studies, rates and reasons for failing to undergo pancreatectomy following NT vary based on anatomic stage. These pooled resection rates may inform patients and providers on the likelihood to attain surgical resection following NT for PR, BR, and LA PDAC and will serve as important benchmarks for future prospective trials. Future research should identify opportunities to decrease attrition and optimize outcomes of NT for PDAC.

Safety and efficacy of PTH 1-34 and 1-84 therapy in chronic hypoparathyroidism: a meta-analysis of prospective trials

Safety and efficacy of PTH 1-34 and 1-84 therapy in chronic hypoparathyroidism: a meta-analysis of prospective trials

357P Comparison between immunotherapy and chemotherapy as neoadjuvant setting in resectable non-small cell lung cancer: A systematic review and meta-analysis of prospective trials

357P Comparison between immunotherapy and chemotherapy as neoadjuvant setting in resectable non-small cell lung cancer: A systematic review and meta-analysis of prospective trials

38: Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer: A Systematic Review and Meta-Analysis of Prospective Trials

38: Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer: A Systematic Review and Meta-Analysis of Prospective Trials

1032 Evaluation viability in patients with ventricular dysfunction by 2D speckle tracking echocardiography: the impact of low dose dobutamine. A meta-analysis of prospective trials

Abstract Background 2D-Speckle tracking echocardiography (2DSTE) has been used for the assessment of myocardial viability in patients with artery disease and left ventricular (LV) dysfunction. Aim The purpose of this analysis was to evaluate the diagnostic accuracy of 2DSTE using longitudinal (LS) and rest circumferential strain (CS) in this setting with or without low dose dobutamine (LDD) infusion. Methods A systematic review of MEDLINE, Cochrane, and Embase for all the prospective trials using 2DSTE to assess myocardial viability until January 2019 was done. Studies that utilized 2DSTE before coronary revascularisation and used the wall motion evaluation in the long term after the revascularisation as a reference were included. A standard approach of meta-analysis for diagnostic tests and a bivariate analysis of sensitivity, specificity, positive likelihood ratio(+LR), and negative likelihood (-LR) were performed. In addition, direct comparison analysis was done to only studies that compared the tests in the same patients. Results A total of 24 studies of 2DSTE evaluating myocardial viability with 1173 patients (mean age 66 years, 72% male, and mean left ventricular ejection fraction was 45%) fulfilled the inclusion criteria. Eight studies used LS, 8 studies used CS, 4 studies used LS with LDD, and 4 studies used CS with LDD. LS and CS with LDD provided higher +LR ( 4.2 and 4, respectively) as well as a best specificity when compared with LS and CS (81% CI: 65- 92% vs 68% CI: 60- 75%, p = 0.04, and 81% CI: 64-91% vs 66% CI: 59-72%, p= 0.02, respectively) for predicting improved segmental LV contractile function after revascularization. The sensitivities of different 2DSTE tests for detection the viability were not statistically different. The direct comparison of the studies with the same patients yielded similar results. Conclusions Using LDD with LS and CS analysis significantly improve specificity of the tests. Therefore, the use of a low dose of the dobutamine can be recommended to improve the accuracy of the 2DSTE for detection of viable myocardium following myocardial infarction. Abstract 1032 Figure. Summary ROC Curves

Stereotactic body radiation therapy for prostate cancer: systematic review and meta-analysis of prospective trials.

Background: Despite the increasing worldwide utilization of stereotactic body radiation therapy (SBRT) for prostate cancer, there are no known summative data regarding its safety and efficacy. To address this knowledge gap, we conducted a PRISMA-guided systematic review and meta-analysis of prospective prostate SBRT trials. Results: Fourteen trials with a total of 2,038 patients were included. Median follow-up was 37 months (range 6-55 months). Most patients had cT1-T2a, Gleason ≤7 disease with median pre-treatment PSAs of 5–10; 1,042 (51%) were low-risk, 744 (37%) were intermediate-risk, 158 (8%) were high-risk, and the remainder were unreported. Doses ranged from 33.5–50.0 Gy, most typically in 5 fractions, with nearly all studies delivering nondaily fractionation with some type of daily image guidance. Outcomes were converted into counts at the end of one year. The pooled rate of FFBF was 98% [95% confidence interval, 97–98%]. The pooled rate of late grade ≥3 gastrointestinal and genitourinary toxicities were 1% [0–5%] and 2% [1–3%], respectively. Methods: PubMed and Google Scholar were queried for prospective studies evaluating survival and/or toxicity outcomes in SBRT (≤5 fractions) for localized prostate cancer. Pooled rates of freedom from biochemical failure (FFBF) and late grades ≥3 gastrointestinal (GI) and genitourinary (GU) toxicities were assessed. Meta-analysis of proportions was logit transformed and pooled using generalized linear mixed models (both fixed and random effects) and subsequently back transformed to standard proportions. Conclusions: Despite the lack of long-term follow-up and heterogeneity of the available evidence, prostate SBRT affords appropriate biochemical control with few high-grade toxicities. These data have implications for ongoing worldwide utilization of prostate SBRT as well as ongoing prospective investigations.

Comparing Cognitive Decline after Radiotherapy for Brain Metastases: A Meta-Analysis of Prospective Trials

The incidence of brain metastases continues to rise due to improved systemic therapies and expanded screening efforts. Whole-brain radiation therapy (WBRT) has been a long-utilized therapy. However, its association with early cognitive decline has led to the development of stereotactic radiosurgery (SRS), the addition of Memantine (WBRT+M), and hippocampal avoidance (HA-WBRT); as efforts to mitigate the development of neurocognitive deficits. We conducted a meta-analysis to quantify and compare the proposed benefits of these therapies. A PICOS/PRISMA/MOOSE selection protocol was utilized to select prospective trials published between 2009 and 2019 to reflect modern therapy. Weighted random effects meta-analyses were conducted, where the DerSimonian and Laird method was used to calculate between study variance. WBRT was compared to SRS, WBRT+M, and HA-WBRT using meta-regression and the Wald-type test, where the null hypothesis was rejected for p<0.05. Heterogeneity was assessed using the I2 statistic and Cochran’s Q-Test. Five randomized prospective trials consisting of 1,005 patients (442 WBRT, 207 SRS, 256 WBRT+M, and 100 HA-WBRT) were selected. Median patient age was 62 years WBRT, 61 SRS, 63 WBRT+M, and 61 HA-WBRT. The most common definition of cognitive failure was a failure or at least 1 standard deviation decrease on any cognitive test, and was assessed at the first follow-up period, which was at 3 or 4 months post-treatment. For WBRT, cognitive failure rates ranged from 51.9%-59.6%, under the random effects model the summary effect size was 53.2% (95% Confidence Interval [CI]: 48.5%-57.8%). For WBRT+M, 43.7% (95% CI: 37.7%-49.8%) of patients experienced cognitive failure at 3 months. For HA-WBRT, 33.3% (95% CI: 28.6%-52%) of patients experienced cognitive failure at 4 months. For SRS, cognitive failure rates ranged from 20%-24%, the summary effect size was 20.9% (95% CI: 15.7%-26.7%). When comparing to WBRT, SRS (p<0.0001), WBRT+M (p=0.016), and HA-WBRT (p=0.0003) had statistically lower rates of cognitive failure. No heterogeneity was noted for each of the outcomes (I2=0% and Q-Test p>0.05). Summary effect sizes for total intracranial control rates at the first follow-up were: 87.4% (95% CI: 73.4%-96.7%) WBRT, 77.2% (95% CI: 70.8%-83.1%) SRS, and 63% (95% CI: 57%-68.8%) WBRT+M. Total intracranial failure rates were not reported for HA-WBRT. Stereotactic radiosurgery results in the lowest rate of neurocognitive dysfunction following treatment for brain metastases. In patients with brain metastases who may benefit from WBRT over SRS, WBRT with the addition of memantine and/or hippocampal avoidance is associated with a decreased risk of neurocognitive dysfunction.

Abstract 17223: Castle of Stone or Straw, Radiofrequency Ablation of Atrial Fibrillation in Heart Failure?

Introduction: Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure. Hypothesis: The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials. Methods: Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed. Results: A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P&lt;0.001). Conclusions: Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic.

Tu1188 A Meta-Analysis of Prospective Trials: Lower Esophageal Sphincter Pressures in Adult Achalasia Patients Managed With Peroral Endoscopic Myotomy (POEM)

Tu1188 A Meta-Analysis of Prospective Trials: Lower Esophageal Sphincter Pressures in Adult Achalasia Patients Managed With Peroral Endoscopic Myotomy (POEM)

P044 - Systematic review and Meta-analysis of prospective trials and retrospective studies comparing suprapubic and transurethral catheterization after robot-assisted laparoscopic prostatectomy

P044 - Systematic review and Meta-analysis of prospective trials and retrospective studies comparing suprapubic and transurethral catheterization after robot-assisted laparoscopic prostatectomy

Microvascular obstruction detected by cardiac MRI after AMI for the prediction of LV remodeling and MACE: A meta-analysis of prospective trials

Microvascular obstruction detected by cardiac MRI after AMI for the prediction of LV remodeling and MACE: A meta-analysis of prospective trials

CMR imaging for the evaluation of myocardial stunning after acute myocardial infarction: a meta-analysis of prospective trials

Myocardial stunning is an important sequela of acute coronary syndromes and its determination might affect decisions on defibrillator implantation and assist devices after myocardial infarction (AMI). The aim of the study was to evaluate and compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of cardiac magnetic resonance imaging (CMR) assessing myocardial stunning after acute myocardial infarction using low-dose dobutamine (LDD), end-diastolic wall thickness, and contrast delayed enhancement (DE). A systematic review of Medline, Embase, and Cochrane for all prospective trials assessing myocardial stunning by CMR following AMI was performed using a standard approach for meta-analysis for diagnostic test and a bivariate analysis. Search results revealed 9384 studies, out of which 17 met criteria. A total of 634 patients (mean age 59 years, 85% male, mean left ventricular ejection fraction: 52%) were included. DE-CMR had a weighted sensitivity of 87% and specificity of 68% to detect myocardial stunning using 50% transmurality as a cut-off, with a PPV and NPV of 83 and 72%, respectively. With an overall diagnostic accuracy of 82%, LDD-CMR had a sensitivity of 67% and a specificity of 81%, with a PPV and NPV of 82 and 63%, respectively. LDD showed an overall accuracy of 74%. DE-CMR has a higher sensitivity, whereas LDD-CMR has a higher specificity for the detection of viable stunned myocardium following myocardial infarction. Whether the combination of DE and LDD may improve the prediction of myocardial recovery remains to be determined.