Effects of mineralocorticoid receptor antagonists in patients with preserved ejection fraction: a meta-analysis of randomized clinical trials

BMC Medicine

Jianping Bin¹  Yulin Liao¹  Xiaobo Huang¹  Yongkang Lu¹  He Wang¹  Yanmei Chen¹ 

[1] State Key Lab for Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China

关键词: Randomized controlled trial;    Preserved ejection fraction;    Mineralocorticoid receptor antagonists;    Meta-analysis;   

Others  :  1109802
DOI  :  10.1186/s12916-014-0261-8

 received in 2014-09-24, accepted in 2014-12-17,  发布年份 2015

【 摘 要 】

Background

Mineralocorticoid receptor antagonists (MRAs) have been shown to be effective in patients with heart failure or myocardial infarction complicated by a reduced ejection fraction. However, the role of MRAs in patients with preserved ejection fraction (PEF) remains to be clarified. We aimed to summarize the evidence for the efficacy of MRAs in patients with either heart failure with PEF (HF-PEF) or myocardial infarction with PEF (MI-PEF).

Methods

We searched PubMed, EMBASE, Cochrane Library, and clinical trials databases for randomized controlled trials, through June 2014, assessing MRA treatment in HF-PEF or MI-PEF patients. Fourteen randomized controlled trials (MI-PEF, 5; HF-PEF, 9; n = 6,428 patients) were included.

Results

MRA treatment reduced the risk of hospitalization for heart failure (relative risk, 0.83; 95% confidence interval [CI], 0.70 to 0.98), improved quality of life (weighted mean difference [WMD], −5.16; 95% CI, −8.03 to −2.30), left ventricular end-diastolic diameter (standardized mean difference, −0.21; 95% CI, 0.32 to −0.11), and serum amino-terminal peptide of procollagen type-III level (WMD, −1.50, 95% CI, −1.72 to −1.29) in patients with PEF. In addition, MRAs reduced E/e'(an echocardiographic estimate of filling pressure for assessment of diastolic function; WMD, −1.82; 95% CI, −2.23 to −1.42) in HF-PEF patients and E/A ratio (the ratio of early to late diastolic transmitral flow; WMD, 0.12; 95% CI, 0.10 to 0.14) in MI-PEF patients. However, all-cause mortality was not improved by MRAs in either HF-PEF (P = 0.90) or MI-PEF (P = 0.27) patients.

Conclusions

MRA treatment in PEF patients led to reduced hospitalization for heart failure, quantifiable improvements in quality of life and diastolic function, and reversal of cardiac remodeling, but did not provide any all-cause mortality benefit.

【 授权许可】

   
2015 Chen et al.; licensee BioMed Central.

【 图 表 】

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