Abdelnabi, Mohamed

Abstract Background Left Ventricular Assist Devices (LVADs) and heart transplantation stand out as the two well-established and effective therapeutic approaches for managing patients with advanced heart failure. Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to improve functional capacity in patients with LVAD. Purpose We aim to assess the efficacy and safety of EBCR in patients with LVAD. Also, to compare high-intensity (HIT) versus moderate-intensity (MIT) EBCR regimens in patients with LVAD. Methods A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) studies obtained from PubMed, Embase Cochrane, Scopus, and WOS until January 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using standardized mean difference (SMD) with a 95% confidence interval (CI). Results Six RCTs with 160 patients were included. There was no significant difference between EBCR and standard care regarding peak VO2 change [SMD: 0.24 with 95% CI (-0.14, 0.62), P= 0.21] and six-minute walk distance (6-MWD) change [SMD: 0.28 with 95% CI (-0.11, 0.66), P= 0.16]. Also, there was no significant difference between HIT and MIT exercise regarding peak VO2 change [SMD: 0.20 with 95% CI (-0.41, 0.82), P= 0.52] and 6-MWD change [SMD: 0.07 with 95% CI (-0.54, 0.69), P= 0.81]. Moreover, EBCR was associated with a significant decrease in the incidence of any adverse events when compared to usual care with [RR: 0.80 with 95% CI (0.65, 0.99), P= 0.04], while there was no significant difference between HIT and MIT exercise regarding the incidence of any adverse events [RR: 0.38 with 95% CI (0.02, 9.22), P= 0.55]. Conclusion EBCR did not improve functional capacity in patients with LVAD, with no significant effect on peak VO2 or 6-MWD.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent metabolic disorder characterized by excessive hepatic fat accumulation. Intermittent fasting (IF) has emerged as a potential therapeutic strategy with the ability to induce weight loss, improve insulin sensitivity and reduce hepatic steatosis. We aim to compare the efficacy of different IF regimens for MASLD management. A systematic review and network meta-analysis of randomized controlled trials investigating different IF regimens for MASLD. PubMed, EMBASE, WOS, SCOPUS and Cochrane Central Register of Controlled Trials were searched until 10 April 2023. Analysis was performed using R software with the meta and netmeta packages. Mean difference (MD) was used to pool continuous outcomes with 95% confidence intervals (CIs). Our meta-analysis was registered in PROSPERO (CRD42023418467). Our meta-analysis included eight randomized controlled trials with a total of 635 participants. The 5 : 2 diet significantly improved liver stiffness (MD, −0.32; 95% CI, −0.55 to −0.09; P < 0.01). Time-restricted feeding significantly improved liver steatosis (controlled attenuation parameter score) (MD, −39.83; 95% CI, −64.78 to −14.87; P < 0.01). No significant changes were observed in asparate aminotransferase, gamma-glutamyl transpeptidase, low-density lipoproteins cholesterol, total cholesterol, triglyceride levels, basal metabolic index, blood pressure, Homeostatic Model Assessment of Insulin Resistance, fasting blood sugar, lean body mass or waist circumference across all IF regimens. However, alternate-day fasting showed positive results in anthropometric measures, including significant improvements in lean body mass, waist circumference, fat mass and weight reduction (P < 0.05). IF regimens showed various positive effects on clinical outcomes in MASLD patients; however, these effects were not consistent. Therefore, a patient-tailored IF regimen should be considered.