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Effect of mineralocorticoid receptor antagonists on cardiac structure and function in patients with diastolic dysfunction and heart failure with preserved ejection fraction: a meta-analysis and systematic review

Citation

Pandey, A and Garg, S and Matulevicius, SA and Shah, AM and Garg, J and Drazner, MH and Amin, A and Berry, JD and Marwick, TH and Marso, SP and de Lemos, JA and Kumbhani, DJ, Effect of mineralocorticoid receptor antagonists on cardiac structure and function in patients with diastolic dysfunction and heart failure with preserved ejection fraction: a meta-analysis and systematic review, Journal of the American Heart Association, 4, (10) Article e002137. ISSN 2047-9980 (2015) [Refereed Article]


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Copyright 2015 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY-NC 4.0) http://creativecommons.org/licenses/by-nc/4.0/

DOI: doi:10.1161/JAHA.115.002137

Abstract

Background: There has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta-analysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF.

Methods & Results: Randomized, controlled clinical trials evaluating the efficacy of MRAs in patients with diastolic dysfunction or HFPEF were included. The primary outcome was change in E/e', a specific measure of diastolic function. Secondary outcomes included changes in other measures of diastolic function, LV structure, surrogate markers for myocardial fibrosis (carboxy-terminal peptide of procollagen type I [PICP] and amino-terminal peptide of pro-collagen type-II [PIIINP]), blood pressure, and exercise tolerance. In the pooled analysis, MRA use was associated with significant reduction in E/e' (weighted mean difference [WMD] [95% confidence interval {CI}]: -1.68 [-2.03 to -1.33]; P < 0.0001) and deceleration time (WMD [95% CI]: -12.0 ms [-23.3 to -0.7]; P = 0.04) as compared with control, suggesting and improvement in diastolic function. Furthermore, blood pressure and levels of PIIINP and PICP were also significantly reduced with MRA therapy with no significant change in LV mass or dimensions.

Conclusion: MRA therapy in patients with asymptomatic diastolic dysfunction or HFPEF is associated with significant improvement in diastolic function and markers of cardiac fibrosis without a significant change in LV mass or dimensions.

Item Details

Item Type:Refereed Article
Keywords:diastolic dysfunction, heart failure with preserved ejection fraction, mineralocorticoid receptor antagonist
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:103626
Year Published:2015
Web of Science® Times Cited:25
Deposited By:Menzies Institute for Medical Research
Deposited On:2015-10-20
Last Modified:2017-11-02
Downloads:344 View Download Statistics

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