Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta-Analysis and Systematic Review.
Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta-Analysis and Systematic Review.
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DOI：
10.1161/jaha.115.002137
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发表时间：
2015-10-12
影响因子：
5.4
通讯作者：
Kumbhani DJ
中科院分区：
文献类型：
--
作者：
Pandey A;Garg S;Matulevicius SA;Shah AM;Garg J;Drazner MH;Amin A;Berry JD;Marwick TH;Marso SP;de Lemos JA;Kumbhani DJ
盐皮质激素受体拮抗剂（MRA）在射血分数保留性心力衰竭（HFPEF）患者中的应用越来越受到关注。然而，缺乏对这些患者的左心室（LV）结构和功能的MRA影响的综合评价。在这项Meta分析中，我们评价了MRA对舒张功能不全或HFPEF患者左室结构和功能的影响。纳入了评价MRA在舒张功能障碍或HFPEF患者中疗效的随机对照临床试验。主要结果是E/e '的变化，这是舒张功能的一个特定指标。次要结局包括舒张功能、LV结构、心肌纤维化替代标志物（I型前胶原羧基端肽[PICP]和II型前胶原氨基端肽[PIIINP]）、血压和运动耐量的其他指标的变化。在汇总分析中，MRA的使用与E/e'的显著降低相关。（加权平均差[WMD] [95%置信区间{CI}]：-1.68 [-2.03至-1.33]; P<0.0001）和减速时间（WMD [95%CI]：−12.0 ms [−23.3至−0.7]; P=0.04）与对照组相比，提示舒张功能改善。此外，血压和PIIINP和PICP水平也显着降低与MRA治疗左室质量或尺寸没有显着变化。 无症状舒张功能障碍或HFPEF患者的MRA治疗与舒张功能和心脏纤维化标志物的显著改善相关，而LV质量或尺寸无显著变化。
There has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta‐analysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF. Randomized, controlled clinical trials evaluating the efficacy of MRAs in patients with diastolic dysfunction or HFPEF were included. The primary outcome was change in E/e’, a specific measure of diastolic function. Secondary outcomes included changes in other measures of diastolic function, LV structure, surrogate markers for myocardial fibrosis (carboxy‐terminal peptide of procollagen type I [PICP] and amino‐terminal peptide of pro‐collagen type‐II [PIIINP]), blood pressure, and exercise tolerance. In the pooled analysis, MRA use was associated with significant reduction in E/e’ (weighted mean difference [WMD] [95% confidence interval {CI}]: −1.68 [−2.03 to −1.33]; P<0.0001) and deceleration time (WMD [95% CI]: −12.0 ms [−23.3 to −0.7]; P=0.04) as compared with control, suggesting and improvement in diastolic function. Furthermore, blood pressure and levels of PIIINP and PICP were also significantly reduced with MRA therapy with no significant change in LV mass or dimensions. MRA therapy in patients with asymptomatic diastolic dysfunction or HFPEF is associated with significant improvement in diastolic function and markers of cardiac fibrosis without a significant change in LV mass or dimensions.