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.

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.

• Authors: Ambarish Pandey, Sushil Garg, Susan A Matulevicius, Amil M Shah, Jalaj Garg, Mark H Drazner, Alpesh Amin, Jarett D Berry, Thomas H Marwick, Steven P Marso, James A de Lemos, Dharam J Kumbhani
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 4 Issue 10 Pg. e002137 (Oct 12 2015) ISSN: 2047-9980 [Electronic] England
• PMID: 26459931 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Chemical References

• Mineralocorticoid Receptor Antagonists

Topics

• Chi-Square Distribution
• Diastole (drug effects)
• Fibrosis
• Heart Failure (diagnosis, drug therapy, physiopathology)
• Humans
• Mineralocorticoid Receptor Antagonists (adverse effects, therapeutic use)
• Randomized Controlled Trials as Topic
• Recovery of Function
• Stroke Volume
• Treatment Outcome
• Ventricular Dysfunction, Left (diagnosis, drug therapy, physiopathology)
• Ventricular Function, Left (drug effects)
• Ventricular Remodeling (drug effects)