Abstract | BACKGROUND: METHODS AND RESULTS: We searched several databases including PubMed and the Cochrane Collaboration, for randomized controlled trials (RCTs) that assessed spironolactone treatment in HFmrEF and HFpEF. Eleven RCTs including 4539 patients were included. Spironolactone reduced hospitalizations (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.73-0.95; P = .006), improved New York Heart Association functional classifications (NYHA-FC) (OR, 0.35; 95% CI, 0.19-0.66; P = .001), decreased the levels of brain natriuretic peptide (BNP) (mean difference [MD], - 44.80 pg/mL; 95% CI, -73.44--16.17; P = .002), procollagen type I C-terminal propeptide ( PICP) (MD, -27.04 ng/mL; 95% CI, -40.77--13.32, P < .001) in HFmrEF and HFpEF. Besides, it improved 6-minute walking distances (6-MWD) (standard weighted mean difference [SMD], 0.45 m; 95% CI, 0.27-0.64; P < .001), decreased amino-terminal peptide of procollagen type-III ( PIIINP) (SMD, -0.37 μg/L; 95% CI, -0.59--0.15; P = .001) in HFpEF only. The risks of hyperkalemia (P<.001) and gynecomastia (P<.001) were increased. CONCLUSION: Patients with HFmrEF and HFpEF could benefit from spironolactone treatment, with reduced hospitalizations, BNP levels, improved NYHA-FC, alleviated myocardial fibrosis by decreasing serum PICP in HFmrEF and HFpEF, decreased PIIINP levels and increased 6-MWD only in HFpEF. The risks of hyperkalemia and gynecomastia were significantly increased with the spironolactone treatment.
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Authors | Yajie Xiang, Wenhai Shi, Zhuolin Li, Yunjing Yang, Stephen Yishu Wang, Rui Xiang, Panpan Feng, Li Wen, Wei Huang |
Journal | Medicine
(Medicine (Baltimore))
Vol. 98
Issue 13
Pg. e14967
(Mar 2019)
ISSN: 1536-5964 [Electronic] United States |
PMID | 30921200
(Publication Type: Journal Article, Meta-Analysis)
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Chemical References |
- Peptide Fragments
- Procollagen
- procollagen Type III-N-terminal peptide
- procollagen type I carboxy terminal peptide
- Natriuretic Peptide, Brain
- Spironolactone
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Topics |
- Heart Failure
(drug therapy, mortality, physiopathology)
- Hospitalization
(statistics & numerical data)
- Humans
- Natriuretic Peptide, Brain
(biosynthesis)
- Peptide Fragments
(biosynthesis)
- Procollagen
(biosynthesis)
- Randomized Controlled Trials as Topic
- Risk Factors
- Spironolactone
(therapeutic use)
- Stroke Volume
(drug effects, physiology)
- Walking Speed
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