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Effect of mineralocorticoid receptor antagonists on cardiac function in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials.
Heart Fail Rev. 2019 05; 24(3):367-377.HF

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a disease with limited evidence-based treatment options. Mineralocorticoid receptor antagonists (MRA) offer benefit in heart failure with reduced ejection fraction (HFrEF), but their impact in HFpEF remains unclear. We therefore evaluated the effect of MRA on echocardiographic, functional, and systemic parameters in patients with HFpEF by a systematic review and meta-analysis. We searched MEDLINE, EMBASE, clinicaltrials.gov , and Cochrane Clinical Trial Collection to identify randomized controlled trials that (a) compared MRA versus placebo/control in patients with HFpEF and (b) reported echocardiographic, functional, and/or systemic parameters relevant to HFpEF. Studies were excluded if: they enrolled asymptomatic patients; patients with HFrEF; patients after an acute coronary event; compared MRA to another active comparator; or reported a follow-up of less than 6 months. Primary outcomes were changes in echocardiographic parameters. Secondary end-points were changes in functional capacity, quality of life measures, and systemic parameters. Quantitative analysis was performed by generating forest plots and calculating effect sizes by random-effect models. Between-study heterogeneity was assessed through Q and I2 statistics. Nine trials with 1164 patients were included. MRA significantly decreased E/e' (mean difference - 1.37, 95% confidence interval - 1.72 to - 1.02), E/A (- 0.04, - 0.08 to 0.00), left ventricular end-diastolic diameter (- 0.78 mm, - 1.34 to - 0.22), left atrial volume index (- 1.12 ml/m2, - 1.91 to - 0.33), 6-min walk test distance (- 11.56 m, - 21 to - 2.13), systolic (- 4.75 mmHg, - 8.94 to - 0.56) and diastolic blood pressure (- 2.91 mmHg, - 4.15 to - 1.67), and increased levels of serum potassium (0.23 mmol/L, 0.19 to 0.28) when compared with placebo/control. In patients with HFpEF, MRA treatment significantly improves indices of cardiac structure and function, suggesting a decrease in left ventricular filling pressure and reverse cardiac remodeling. MRA increase serum potassium and decrease blood pressure; however, a small decrease in 6-min-walk distance is also noted. Larger prospective studies are warranted to provide definitive answers on the effect of MRA in patients with HFpEF.

Authors+Show Affiliations

Department of Health Policy, The London School of Economics and Political Science, London, UK. c.kapelios@lse.ac.uk. Cardiology Department, Laiko General Hospital, 17 Agiou Thoma Street, 11 527, Athens, Greece. c.kapelios@lse.ac.uk.Department of Health Policy, The London School of Economics and Political Science, London, UK. Augusta University-University of Georgia Medical Partnership, Athens, GA, USA.Department of Health Policy, The London School of Economics and Political Science, London, UK. Department of Cardiology and Angiology II, University Heart Center Freiburg • Bad Krozingen, Bad Krozingen, Germany.Department of Health Policy, The London School of Economics and Political Science, London, UK. Heart Failure Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

30618017

Citation

Kapelios, Chris J., et al. "Effect of Mineralocorticoid Receptor Antagonists On Cardiac Function in Patients With Heart Failure and Preserved Ejection Fraction: a Systematic Review and Meta-analysis of Randomized Controlled Trials." Heart Failure Reviews, vol. 24, no. 3, 2019, pp. 367-377.
Kapelios CJ, Murrow JR, Nührenberg TG, et al. Effect of mineralocorticoid receptor antagonists on cardiac function in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Heart Fail Rev. 2019;24(3):367-377.
Kapelios, C. J., Murrow, J. R., Nührenberg, T. G., & Montoro Lopez, M. N. (2019). Effect of mineralocorticoid receptor antagonists on cardiac function in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Heart Failure Reviews, 24(3), 367-377. https://doi.org/10.1007/s10741-018-9758-0
Kapelios CJ, et al. Effect of Mineralocorticoid Receptor Antagonists On Cardiac Function in Patients With Heart Failure and Preserved Ejection Fraction: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Heart Fail Rev. 2019;24(3):367-377. PubMed PMID: 30618017.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of mineralocorticoid receptor antagonists on cardiac function in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. AU - Kapelios,Chris J, AU - Murrow,Jonathan R, AU - Nührenberg,Thomas G, AU - Montoro Lopez,Maria N, PY - 2019/1/9/pubmed PY - 2019/1/9/medline PY - 2019/1/9/entrez KW - Diastolic function KW - Eplerenone KW - Heart failure KW - Mineralocorticoid receptor antagonist KW - Spironolactone SP - 367 EP - 377 JF - Heart failure reviews JO - Heart Fail Rev VL - 24 IS - 3 N2 - Heart failure with preserved ejection fraction (HFpEF) is a disease with limited evidence-based treatment options. Mineralocorticoid receptor antagonists (MRA) offer benefit in heart failure with reduced ejection fraction (HFrEF), but their impact in HFpEF remains unclear. We therefore evaluated the effect of MRA on echocardiographic, functional, and systemic parameters in patients with HFpEF by a systematic review and meta-analysis. We searched MEDLINE, EMBASE, clinicaltrials.gov , and Cochrane Clinical Trial Collection to identify randomized controlled trials that (a) compared MRA versus placebo/control in patients with HFpEF and (b) reported echocardiographic, functional, and/or systemic parameters relevant to HFpEF. Studies were excluded if: they enrolled asymptomatic patients; patients with HFrEF; patients after an acute coronary event; compared MRA to another active comparator; or reported a follow-up of less than 6 months. Primary outcomes were changes in echocardiographic parameters. Secondary end-points were changes in functional capacity, quality of life measures, and systemic parameters. Quantitative analysis was performed by generating forest plots and calculating effect sizes by random-effect models. Between-study heterogeneity was assessed through Q and I2 statistics. Nine trials with 1164 patients were included. MRA significantly decreased E/e' (mean difference - 1.37, 95% confidence interval - 1.72 to - 1.02), E/A (- 0.04, - 0.08 to 0.00), left ventricular end-diastolic diameter (- 0.78 mm, - 1.34 to - 0.22), left atrial volume index (- 1.12 ml/m2, - 1.91 to - 0.33), 6-min walk test distance (- 11.56 m, - 21 to - 2.13), systolic (- 4.75 mmHg, - 8.94 to - 0.56) and diastolic blood pressure (- 2.91 mmHg, - 4.15 to - 1.67), and increased levels of serum potassium (0.23 mmol/L, 0.19 to 0.28) when compared with placebo/control. In patients with HFpEF, MRA treatment significantly improves indices of cardiac structure and function, suggesting a decrease in left ventricular filling pressure and reverse cardiac remodeling. MRA increase serum potassium and decrease blood pressure; however, a small decrease in 6-min-walk distance is also noted. Larger prospective studies are warranted to provide definitive answers on the effect of MRA in patients with HFpEF. SN - 1573-7322 UR - https://www.unboundmedicine.com/medline/citation/30618017/Effect_of_mineralocorticoid_receptor_antagonists_on_cardiac_function_in_patients_with_heart_failure_and_preserved_ejection_fraction:_a_systematic_review_and_meta_analysis_of_randomized_controlled_trials_ L2 - https://doi.org/10.1007/s10741-018-9758-0 DB - PRIME DP - Unbound Medicine ER -