Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis.
Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis.
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DOI：
10.1093/europace/euv366
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发表时间：
2016-05
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通讯作者：
Tong Liu;P. Korantzopoulos;Qingmiao Shao;Zhiwei Zhang;K. Letsas;Guangping Li
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作者：
Tong Liu;P. Korantzopoulos;Qingmiao Shao;Zhiwei Zhang;K. Letsas;Guangping Li
目的醛固酮参与心房重构，是上游治疗的潜在靶点。越来越多的证据表明，盐皮质激素受体阻滞剂可能对房颤（AF）的发展有有利的影响，尽管一些有争议的结果已经发表。因此，我们进行了荟萃分析的随机临床试验（RCT）和观察性研究，以检查盐皮质激素受体拮抗剂（MRA）对AF的保护作用。方法和结果的1337最初确定的记录，3个RCT和2个观察性研究，3640例患者进行了最后分析。纳入研究的汇总分析表明，与对照组相比，接受MRA治疗的患者的AF风险降低31%[相对比（RR）：0.69; 95%置信区间（CI）：0.58-0.83]，研究间无任何异质性（I（2）= 0%）。该效应在RCT（RR：0.72; 95% CI：0.55-0.94）和观察性研究（RR：0.67; 95% CI：0.53-0.84）中一致，无异质性。此外，MRA可降低心力衰竭（HF）（RR：0.63; 95% CI：0.50-0.80）和心脏手术后（RR：0.77; 95% CI：0.61-0.98）的AF风险。分析依普利酮和螺内酯的相对影响，我们发现只有依普利酮显著降低AF负担（RR：0.64; 95%CI：0.44-0.90）。结论：我们的荟萃分析表明，MRA可能是有效的预防AF，特别是在HF设置。然而，目前还没有足够的数据表明醛固酮拮抗剂仅用于预防房颤。需要在不同临床环境中进行长期随访的大型RCT，以阐明MRA对AF的影响。
AIMS Aldosterone has been implicated in atrial remodelling representing a potential target for upstream therapies. Accumulating evidence suggests that mineralocorticoid receptor blockade may have favourable effects on atrial fibrillation (AF) development, although some controversial results have been published. We, therefore, conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies in order to examine the protective role of mineralocorticoid receptor antagonists (MRAs) on AF. METHODS AND RESULTS Of the 1337 initially identified records, 3 RCTs and 2 observational studies with 3640 patients were finally analysed. The pooled analysis of the included studies demonstrated that patients treated with MRAs have 31% lower risk of AF compared with controls [relative ratio (RR): 0.69; 95% confidence interval (CI): 0.58-0.83] without any heterogeneity across the studies (I(2) = 0%). This effect was consistent across RCTs (RR: 0.72; 95% CI: 0.55-0.94) and observational studies (RR: 0.67; 95% CI: 0.53-0.84) without heterogeneity. Also, MRAs reduce the risk of AF in both heart failure (HF) (RR: 0.63; 95% CI: 0.50-0.80) and after cardiac surgery (RR: 0.77; 95% CI: 0.61-0.98). Analysing the relative impact of eplerenone and spironolactone, we showed that only eplerenone significantly reduces AF burden (RR: 0.64; 95% CI: 0.44-0.90). CONCLUSION Our meta-analysis suggests that MRAs may be effective in AF prevention especially in the HF setting. However, there are insufficient data for the widespread use of aldosterone antagonists solely for AF prevention. Larger RCTs with long-term follow-up in different clinical settings are needed to clarify the impact of MRAs on AF.