Guo Daoyu, Chen Mei, Zhu Chen, Liu Yang
Department of Internal Medicine and Pediatrics, Clinical College of Qilu Medical University, 255300 Zibo, Shandong, China.
Department of Nursing Science, Clinical College of Qilu Medical University, 255300 Zibo, Shandong, China.
Rev Cardiovasc Med. 2025 Jul 31;26(7):37886. doi: 10.31083/RCM37886. eCollection 2025 Jul.
High thoracic epidural blockade (HTEB) with local anti-sympathetic effects modulates cardiac performance in patients undergoing cardiac or non-cardiac surgeries. However, the short-term cardio-protective effects of HTEB in non-operative patients with ischemic heart disease (IHD) and heart failure (HF) remain unclear. Our study aimed to pool evidence regarding the benefits of adjunctive HTEB intervention in patients with IHD and HF.
Exposures were defined as non-operative patients with IHD and HF who received adjunctive HTEB intervention and/or conventional medical treatment (CMT). The primary outcomes were clinical recovery indicator assessments, electrocardiographic and ultrasonic index improvement, laboratory tests, and hemodynamic benefits provided by adjunctive HTEB treatment. The secondary outcome was the effectiveness rate and adverse side effects after HTEB intervention. The pooled analyses of continuous variables were conducted using a fixed-effects model and the effects were represented by the weighted mean difference (WMD) and a 95% confidence interval (CI). The effective rates of HTEB treatment were represented using odds ratios (ORs, 95% CI) or effect size (ES, 95% CI). The I statistic was used to identify any inconsistency in the pooled results from individual trials. A meta-regression and subgroup analysis were conducted when inconsistencies in individual trials were detected.
HTEB treatment was associated with a significant 10% increase in left ventricular ejection fraction (summary WMD, 9.651 [95% CI: 9.082 to 10.220]), a decline in neuroendocrine hormone levels, myocardial ischemia relief, improvement in hemodynamics, and the reversal of decompensated cardiac remodeling. HTEB treatment is more effective than conventional medical treatment (odds ratio, 5.114 [95% CI: 3.189 to 8.203]) in treating HF and angina pectoris.
Our results suggest that HTEB intervention may be a complementary approach for cardiac rehabilitation in patients with IHD and HF. However, more data are necessary to confirm these findings due to the significant heterogeneity of the included studies.
具有局部抗交感神经作用的高位胸椎硬膜外阻滞（HTEB）可调节接受心脏手术或非心脏手术患者的心脏功能。然而，HTEB对非手术缺血性心脏病（IHD）和心力衰竭（HF）患者的短期心脏保护作用仍不清楚。我们的研究旨在汇总关于HTEB辅助干预对IHD和HF患者益处的证据。
暴露定义为接受HTEB辅助干预和/或传统药物治疗（CMT）的非手术IHD和HF患者。主要结局是临床恢复指标评估、心电图和超声指标改善、实验室检查以及HTEB辅助治疗提供的血流动力学益处。次要结局是HTEB干预后的有效率和不良反应。连续变量的汇总分析采用固定效应模型，效应以加权平均差（WMD）和95%置信区间（CI）表示。HTEB治疗有效率以比值比（ORs，95%CI）或效应量（ES，95%CI）表示。I统计量用于识别各独立试验汇总结果中的任何不一致性。当检测到各独立试验存在不一致性时，进行meta回归和亚组分析。
HTEB治疗与左心室射血分数显著增加10%相关（汇总WMD，9.651[95%CI：9.082至10.220]），神经内分泌激素水平下降，心肌缺血缓解，血流动力学改善，以及失代偿性心脏重塑的逆转。HTEB治疗在治疗HF和心绞痛方面比传统药物治疗更有效（比值比，5.114[95%CI：3.189至8.203]）。
我们的结果表明，HTEB干预可能是IHD和HF患者心脏康复的一种补充方法。然而，由于纳入研究存在显著异质性，需要更多数据来证实这些发现。
