Author + information
- Anurag Bajaj,
- Sukrut Nanavaty,
- John Coppola,
- Hemant Tiwari,
- Tejas Patel and
- Samir Pancholy
Background: Heart failure with preserved ejection fraction (HFpEF) is a common health problem and a major cause of mortality and morbidity. The prognosis worsens with pulmonary hypertension and right sided heart failure. Sildenafil is a phosphodiesterase-5 inhibitor (PDF5I), which selectively reduces pulmonary vascular resistance and is recognized as an effective therapy for pulmonary artery hypertension. The literature evaluating the effect of siladenafil in HFpEF is scant and lacks precision in view of the small patient size. We performed a meta-analysis to evaluate the efficacy of sildenafil on hemodynamic parameters in patients with HFpEF.
Methods: A systematic search of databases, including Pubmed, Web of Science, Google scholar and Cochrane Database was performed by two independent reviewers to identify relevant studies. Studies comparing PDF5I sildanefil versus placebo, with minimum duration of treatment of at least 9 weeks in patients with HFpEF were included. The primary outcome measure was pulmonary artery systolic pressure (PASP) and secondary outcomes were cardiac index (CI), right atrial pressure (RAP), peak oxygen consumption (pVo2), and serious adverse events.
Results: Four randomized controlled studies with a total of 379 patients were included in the analysis. Random-effects method was used. There were no significant differences in PASP (WMD, −5.22 [CI −16.26, 5.81], I2= 99%), CI (WMD, 1.79 [CI −0.91,4.50], I2= 99%), RAP (WMD, −2.45 [CI −7.11,2.20], I2= 95%) and pVO2 (OR, 0.20 [CI 0.09,0.31], I2= 0%). There were a total of 12.8% serious adverse events for the total duration of follow up. There was no significant difference in the rate of serious adverse events between the two groups (OR, 1.51 [CI 0.77,2.96], I2= 0%). Publication bias calculated from PASP analysis showed asymmetry in the funnel plot indicates publication bias.
Conclusions: In patients with HFpEF, Sildenafil did not result in significant improvement in hemodynamic parameters. More randomized controlled trials are needed to define the role of sildenafil in HFpEF.
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: 1121-246
- 2017 American College of Cardiology Foundation