Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trialsReportar como inadecuado




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BMC Cardiovascular Disorders

, 17:150

Non-coronary artery cardiac disease

Abstract

BackgroundPrevious studies suggested that phosphodiesterase 5 inhibitors PDE5i have a beneficial effect in patients with heart failure HF, although the results were inconsistent. We performed a meta-analysis to evaluate the effect of PDE5i in HF patients, and investigated the relationship between PDE5i effects and pulmonary hemodynamics.

MethodWe searched PubMed, EMBASE and the Cochrane Library for randomized controlled trials RCTs that compared PDE5i with placebo in HF with reduced ejection fraction HFrEF or HF with preserved EF HFpEF. PDE5i effects were interpolated according to baseline pulmonary arterial pressure PAP or according to changes in PAP after PDE5i treatment.

ResultsThirteen RCTs enrolling 898 HF patients, and two sub-analysis studies with different study outcomes, were included in the meta-analysis. Among patients with HFrEF, PDE5i improved peak VO2 mean difference MD, 3.76 mL-min-kg; 95% confidence interval CI, 3.27 to 4.25; P < 0.00001, VE-VCO2 slope MD, −6.04; 95% CI, −7.45 to −4.64; P < 0.00001, LVEF MD, 4.30%; 95% CI, 2.18 to 6.42; P < 0.0001, and pulmonary vascular resistance MD, −80.74 dyn·sec-cm; 95% CI, −110.69 to −50.79; P < 0.00001. The effects of PDE5i in patients with HFpEF were heterogeneous. Meta-regression analyses indicated that the beneficial effect of PDE5i was related to the baseline PAP as well as the extent of PDE5i-mediated PAP decrease.

ConclusionPDE5i improved pulmonary hemodynamics and exercise capacity in patients with HFrEF, but not in HFpEF. The relationship between the benefits by PDE5i with the baseline PAP and the changes in PAP indicates the therapeutic potential of PDE5i in HF according to pulmonary hemodynamics.

KeywordsPhosphodiesterase 5 inhibitor Heart failure Pulmonary hypertension Randomized controlled trial Meta-analysis Abbreviations6MWD6-minutes walking distance

Cpc-PHCombined post- and pre-capillary pulmonary hypertension

DPGDiastolic pulmonary gradient

HFHeart failure

HFpEFHeart failure with preserved ejection fraction

HFrEFHeart failure with reduced ejection fraction

Ipc-PHIsolated post-capillary pulmonary hypertension

LVEFLeft ventricular ejection fraction

MDMean difference

mPAPmean pulmonary arterial pressure

PAPPulmonary arterial pressure

PASPPulmonary arterial systolic pressure

PCWPPulmonary capillary wedge pressure

PDE5iPhosphodiesterase 5 inhibitors

PHPulmonary hypertension

PH-LHDPulmonary hypertension in left heart disease

PVRPulmonary vascular resistance

RCTRandomized controlled trial

RRRisk ratio

TPGTranspulmonary gradient

Electronic supplementary materialThe online version of this article doi:10.1186-s12872-017-0576-4 contains supplementary material, which is available to authorized users.





Autor: In-Chang Hwang - Yong-Jin Kim - Jun-Bean Park - Yeonyee E. Yoon - Seung-Pyo Lee - Hyung-Kwan Kim - Goo-Yeong Cho - Dae-Won

Fuente: https://link.springer.com/







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