Short-term Effects of High Thoracic Epidural Blockade in Patients With Ischemic Heart Disease and Heart Failure: A Systematic Review and Data Synthesis

Abstract

Background: 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.

Methods: 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 I² 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.

Results: 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.

Conclusions: 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.

Keywords: heart failure; high thoracic epidural blockade; ischemic heart disease; systematic review.

Fig. 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart and analytical protocol. CNKI, Chinese National Knowledge Infrastructure.

Fig. 2.

An estimation of the publication bias based on the left ventricular ejection fraction (LVEF) effect by the Egger’s test. (A) Case–control studies, (B) case–series studies.