Tags

Type your tag names separated by a space and hit enter

Effects of spironolactone in heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials.
Medicine (Baltimore). 2018 Aug; 97(35):e11942.M

Abstract

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) is a common syndrome, accounting for more than one half of all heart failure patients, which is associated with high morbidity and mortality. But there is little evidence-based therapeutic strategies for the management of HFpEF. Previous studies reported the effects of spironolactone on HFpEF; however, the results were inconsistent. In this meta-analysis, we evaluated the effects of spironolactone on HFpEF.

METHODS

Articles were searched on PubMed, EMBASE, and COCHRANE databases before May, 2017, and were supplemented by hand searches of reference lists of included studies and review articles. Eligible articles were restricted to randomized controlled trials (RCTs). The odds ratios (ORs) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CIs) were calculated to assess the effects of spironolactone in patients with HFpEF.

RESULTS

A total of 7 studies including 4147 participants were analyzed. There were significant improvements on the E/e' index (MD -1.38; 95% CI, -2.03 to -0.73; P < .0001) and E/A velocity ratio (MD -0.05; 95% CI, -0.10 to -0.00; P = .03) under spironolactone treatment compared with placebo, while there was no effect on the deceleration time (MD 1.04; 95% CI, -8.27 to 10.35; P = .83). Subgroup analyses on the E/A velocity ratio showed that there was obvious benefit from spironolactone therapy in patients with follow-up periods >6 months but not in those with follow-up periods ≤6 months. There was no reduction in all-cause mortality and hospitalization compared with placebo. And no improvement in 6-minute walk distance was seen compared with placebo.

CONCLUSION

This meta-analysis demonstrates that the use of spironolactone improves left ventricular diastolic function in patients with HFpEF, whereas it has no effect on all-cause mortality and hospitalization, and the 6-minute walk distance. Further larger size, multicenter, RCTs are required to confirm the effects of spironolactone on patients with HFpEF.

Authors+Show Affiliations

Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital of Shandong University.The Heart Center, Jining First People's Hospital, Jining, Shandong, China.Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital of Shandong University.Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital of Shandong University.Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital of Shandong University.Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital of Shandong University.Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital of Shandong University.Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital of Shandong University.Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital of Shandong University.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

30170387

Citation

Li, Shuai, et al. "Effects of Spironolactone in Heart Failure With Preserved Ejection Fraction: a Meta-analysis of Randomized Controlled Trials." Medicine, vol. 97, no. 35, 2018, pp. e11942.
Li S, Zhang X, Dong M, et al. Effects of spironolactone in heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(35):e11942.
Li, S., Zhang, X., Dong, M., Gong, S., Shang, Z., Jia, X., Chen, W., Yang, J., & Li, J. (2018). Effects of spironolactone in heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials. Medicine, 97(35), e11942. https://doi.org/10.1097/MD.0000000000011942
Li S, et al. Effects of Spironolactone in Heart Failure With Preserved Ejection Fraction: a Meta-analysis of Randomized Controlled Trials. Medicine (Baltimore). 2018;97(35):e11942. PubMed PMID: 30170387.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of spironolactone in heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials. AU - Li,Shuai, AU - Zhang,Xinling, AU - Dong,Mei, AU - Gong,Shu, AU - Shang,Zhi, AU - Jia,Xu, AU - Chen,Wenqiang, AU - Yang,Jianmin, AU - Li,Jifu, PY - 2018/9/2/entrez PY - 2018/9/2/pubmed PY - 2018/9/7/medline SP - e11942 EP - e11942 JF - Medicine JO - Medicine (Baltimore) VL - 97 IS - 35 N2 - BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a common syndrome, accounting for more than one half of all heart failure patients, which is associated with high morbidity and mortality. But there is little evidence-based therapeutic strategies for the management of HFpEF. Previous studies reported the effects of spironolactone on HFpEF; however, the results were inconsistent. In this meta-analysis, we evaluated the effects of spironolactone on HFpEF. METHODS: Articles were searched on PubMed, EMBASE, and COCHRANE databases before May, 2017, and were supplemented by hand searches of reference lists of included studies and review articles. Eligible articles were restricted to randomized controlled trials (RCTs). The odds ratios (ORs) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CIs) were calculated to assess the effects of spironolactone in patients with HFpEF. RESULTS: A total of 7 studies including 4147 participants were analyzed. There were significant improvements on the E/e' index (MD -1.38; 95% CI, -2.03 to -0.73; P < .0001) and E/A velocity ratio (MD -0.05; 95% CI, -0.10 to -0.00; P = .03) under spironolactone treatment compared with placebo, while there was no effect on the deceleration time (MD 1.04; 95% CI, -8.27 to 10.35; P = .83). Subgroup analyses on the E/A velocity ratio showed that there was obvious benefit from spironolactone therapy in patients with follow-up periods >6 months but not in those with follow-up periods ≤6 months. There was no reduction in all-cause mortality and hospitalization compared with placebo. And no improvement in 6-minute walk distance was seen compared with placebo. CONCLUSION: This meta-analysis demonstrates that the use of spironolactone improves left ventricular diastolic function in patients with HFpEF, whereas it has no effect on all-cause mortality and hospitalization, and the 6-minute walk distance. Further larger size, multicenter, RCTs are required to confirm the effects of spironolactone on patients with HFpEF. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/30170387/Effects_of_spironolactone_in_heart_failure_with_preserved_ejection_fraction:_A_meta_analysis_of_randomized_controlled_trials_ L2 - http://dx.doi.org/10.1097/MD.0000000000011942 DB - PRIME DP - Unbound Medicine ER -