Author + information
- Yajie Xiang,
- Wei Huang,
- Yunjing Yang,
- Stephen Yishu Wang and
- Wenhai Shi
Background: Mineralocorticoid receptor antagonists (MRAs) have been shown to reduce mortality and improve symptoms in heart failure patients with reduced ejection fraction (HFrEF). Recent studies have shown promise in using MRAs to treat patients with heart failure with preserved ejection fraction (HFpEF), but the conclusion remains controversial. The aim of this meta-analysis is to investigate the effects of spironolactone on the prognosis of patients with HFpEF.
Methods: We searched PubMed, EMBASE, Cochrane Collaboration Central Register of Controlled Trials, Clinical Trials Databases and China National Knowledge Internet (CNKI) for randomized controlled trials (RCTs) dated through August 2016 to assess spironolactone treatment in HFpEF patients. All statistical analyses were performed using Review Manager 5.3.
Results: Twelve randomized controlled trials (n = 6,974 patients) were included and showed that spironolactone could reduce hospitalization (Odds Ratio [OR], 0.67; 95% Confidence interval [CI], 0.47 to 0.96, P=0.03). It also improved New York Heart Association (NYHA) function classification (Risk Ratio [RR], 0.84; 95% CI, 0.78 to 0.90, P<0.00001) and 6-minute walk distance test (6-MWDT) (Standard weighted mean difference[SMD], 0.45; 95% CI, 0.27 to 0.64, P<0.00001). It reduced the procollagen type I C-terminal propeptide (PICP)(Weighted mean difference [WMD], –27.04; 95% CI, –40.77 to –13.32, P=0.0001), amino-terminal peptide of procollagen type-III (PIIINP)(SMD, –0.37; 95% CI, –0.59 to –0.15, P=0.001) and brain natriuretic peptide (BNP)(WMD, –44.80; 95% CI, –73.44 to –16.17, P=0.002). Furthermore, we also observed some improvement in serum potassium (WMD, 0.25; 95% CI, 0.18 to 0.33, P<0.00001), but the effect on the levels or concentration of aldosterone was not significant (SMD, 0.20; 95% CI, –0.03 to 0.43; Z=1.71, P=0.09). Echo indexes did not differ.
Conclusions: In patients with HFpEF, spironolactone may reduce hospitalization and BNP, reduce the fibrosis in myocardium through decreasing serum PICP and PIIINP, and improve NYHA function classification and 6-MWDT. There was no change in diastolic function from echo indexes.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Heart Failure and Cardiomyopathies: Is Heart Failure With a Normal EF for Real?
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1121-244
- 2017 American College of Cardiology Foundation