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BMC Medicine
Published in: BMC Medicine 1/2015

Open Access 01-12-2015 | Research article

Effects of mineralocorticoid receptor antagonists in patients with preserved ejection fraction: a meta-analysis of randomized clinical trials

Authors: Yanmei Chen, He Wang, Yongkang Lu, Xiaobo Huang, Yulin Liao, Jianping Bin

Published in: BMC Medicine | Issue 1/2015

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Abstract

Background

Mineralocorticoid receptor antagonists (MRAs) have been shown to be effective in patients with heart failure or myocardial infarction complicated by a reduced ejection fraction. However, the role of MRAs in patients with preserved ejection fraction (PEF) remains to be clarified. We aimed to summarize the evidence for the efficacy of MRAs in patients with either heart failure with PEF (HF-PEF) or myocardial infarction with PEF (MI-PEF).

Methods

We searched PubMed, EMBASE, Cochrane Library, and clinical trials databases for randomized controlled trials, through June 2014, assessing MRA treatment in HF-PEF or MI-PEF patients. Fourteen randomized controlled trials (MI-PEF, 5; HF-PEF, 9; n = 6,428 patients) were included.

Results

MRA treatment reduced the risk of hospitalization for heart failure (relative risk, 0.83; 95% confidence interval [CI], 0.70 to 0.98), improved quality of life (weighted mean difference [WMD], −5.16; 95% CI, −8.03 to −2.30), left ventricular end-diastolic diameter (standardized mean difference, −0.21; 95% CI, 0.32 to −0.11), and serum amino-terminal peptide of procollagen type-III level (WMD, −1.50, 95% CI, −1.72 to −1.29) in patients with PEF. In addition, MRAs reduced E/e'(an echocardiographic estimate of filling pressure for assessment of diastolic function; WMD, −1.82; 95% CI, −2.23 to −1.42) in HF-PEF patients and E/A ratio (the ratio of early to late diastolic transmitral flow; WMD, 0.12; 95% CI, 0.10 to 0.14) in MI-PEF patients. However, all-cause mortality was not improved by MRAs in either HF-PEF (P = 0.90) or MI-PEF (P = 0.27) patients.

Conclusions

MRA treatment in PEF patients led to reduced hospitalization for heart failure, quantifiable improvements in quality of life and diastolic function, and reversal of cardiac remodeling, but did not provide any all-cause mortality benefit.
Appendix
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Metadata
Title
Effects of mineralocorticoid receptor antagonists in patients with preserved ejection fraction: a meta-analysis of randomized clinical trials
Authors
Yanmei Chen
He Wang
Yongkang Lu
Xiaobo Huang
Yulin Liao
Jianping Bin
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2015
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-014-0261-8

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