Cheungpasitporn, Wisit

Abstract Background: Previous studies have found various incidences of right ventricular dysfunction (RVD) and its association with clinical outcome. In this systematic review and meta-analysis, we aimed to investigate the impact of the presence of RVD on mortality in patients with ARDS.Method: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies investigating the association between RVD and mortality. Two authors independently evaluated whether studies meet eligibility criteria and extracted the selected patients’ and studies’ characteristics and outcomes. The primary outcome was the association between mortality and the presence of RVD in patients with ARDS. Results: We included 9 studies (N = 1,861 patients) in this meta-analysis. RVD was present in 21.0% (391/1,861). In the pooled meta-analysis, the presence of RVD in patients with ARDS was associated with significantly higher overall mortality (OR: 1.45, 95%CI: 1.13-1.86, p-value = 0.003, I2 = 0%), as well as short-term mortality (OR: 1.48, 95%CI: 1.14-1.93, p-value = 0.003, I2 = 0%).Conclusion: In this systematic review and meta-analysis including 1,861 patients with ARDS, the presence of RVD was significantly associated with increased overall and short-term mortality.Trial registration: The protocol was registered at PROSPERO (CRD42020206521).

Background: Arteriovenous fistula is the most preferred form of vascular access, but stenosis treated by balloon angioplasty is prone to restenosis. Multiple trials have been published with regard to the use of paclitaxel-coated balloon to prolong lesion patency compared to conventional balloon. Although paclitaxel-coated balloon has theoretical appeal, its use has not been widespread nationwide due to cost and lack of large-scale multicenter studies. We performed this meta-analysis to evaluate whether paclitaxel-coated balloon outperforms conventional balloon to prolong target lesion patency. Methods: PubMed/Medline, Clinical Trials.gov, EMBASE, Scopus, Web of Science, and Cochrane Central were searched from inception through April 2019 for studies that investigated the use of paclitaxel-coated balloon in arteriovenous fistula. Results: Ten studies were included in the final meta-analysis: six studies were randomized controlled trials and four studies were cohort studies. There were 911 participants with a mean age of 64.78 (±5.96) years, and 61.89% were male. Outcome of interest was target lesion primary patency, recorded at 1, 3, 6, 7, 12, and 24 months. Meta-analysis of randomized controlled trials shows that paclitaxel-coated balloons did not statistically improve target lesion primary patency compared to conventional balloons at months 1 (odds ratio = 1.54, p = 0.6373), 3 (odds ratio = 0.57, p = 0.0575), 6 (odds ratio = 0.65, p = 0.3644), 7 (odds ratio = 0.63, p = 0.0582), 12 (odds ratio = 0.64, p = 0.0612), and 24 (odds ratio = 0.43, p = 0.3452). Effect of paclitaxel-coated balloons was statistically significant for cohort studies at months 6 (odds ratio = 0.26, p = 0.0007), 12 (odds ratio = 0.21, p = 0.0001), and 24 (odds ratio = 0.23, p = 0.01). Conclusion: Paclitaxel-coated balloon showed no statistically significant improvement over conventional balloons in decreasing fistula stenosis in randomized controlled trial but were significant for cohort studies.