| Objective: To scientifically estimate the safety and efficacy of the treatment of mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction,stematically evaluate the overall level of quality,provide evidence for future clinical application.Methods: PubMed,EMbase,EBSCO,clinical trials databases,the Cochrane Library,CNKI,Wan Fang Data,VIP and CBM were searched for randomized controlled trials investigating the effects of mineralocorticoid receptor antagonists in Heart Failure With Preserved Ejection Fraction patients from January 2002 to January 2017.Two reviewers independently searched literatures according to inclusion and esclusion criteria,extracted data and assessed the methodological quality of included studies.The meta-analysis was conducted by using RevMan 5.2software,selecting fixed or random effects model based on the heterogeneity test.The publication bias was evaluated by funnel plots.Results: Totally,7 studies were included synthetically in the present Meta-analysis.The mineralocorticoid receptor antagonists group and control group were 461 and 461 respectively.This Meta-analysis shows:(1)Compared with control group,the effects of mineralocorticoid receptor antagonists on cardiac diastolic function are:significantly reduce E/e' ratio[WMD=-1.5,95%CI(-2.12,-0.89),P<0.00001],elevate maximum velocity of lateral mitral valve annulus(e')[WMD=0.33,95%CI(0.11,0.55),P=0.003],tended to reduce left atrial volume inedx[WMD=-2.81,95%CI(-5.77,0.16),P=0.06] and decrease E wave deceleration time[WMD=-17.07,95%CI(-34.29,0.16),P=0.05].But MRA can't dramatically increase left ventricular ejection fraction [WMD=0.95,95%CI(-2.15,4.05),P=0.55]or E/A ratio[WMD=0.09,95%CI(-0.14,0.31),P=0.45],can't decrease left ventricular end diastolic diameter[WMD=-0.12,95%CI(-0.35,0.10),P=0.29]or left atrial volume index[WMD=-0.77,95%CI(-2.19,0.65),P=0.29].(2)Effects of mineralocorticoid receptor antagonists on blood pressure and biochemical markers : MRA can significantly reduce systolic blood pressure of HF-PEF[WMD=-7.91,95%CI(-10.61,5.21),P<0.00001]?diastolic blood pressure[WMD=-1.99,95%CI(-3.74,-0.25),P=0.03] ? P ? NP [WMD=-1.08,95%CI(-1.61,-0.55),P<0.0001] ? serum aldosterone [WMD=-5.69,95%CI(-10.97,-0.41),P=0.03] ? glomerular filtration rate [WMD=-4.42,95%CI(-6.91,-1.94),P=0.0005],slightly descrease levels of P?NP [WMD=-7.05,95%CI(-13.79,-0.31),P=0.04],significantly elevate serum potassium levels[WMD=0.22,95%CI(0.16,0.29),P<0.00001].But there's no dramatic effect on BNP[WMD=-36.8,95%CI(-74.06,0.45),P=0.05] ? plasma renin activity[WMD=-0.03,95%CI(-0.07,0.01),P=0.14]or angiotensin ? [WMD=-1.90,95%CI(-6.21,2.40),P=0.39].(3)Effects of MRA on clinical efficacy of patients with HF-PEF:MRA group significantly elevate the KCCQ clinical summary scores[WMD=-5.11,95%CI(-7.98,-2.24),P=0.0005].Although MRA can increase the 6 minute walk distance[WMD=45.11,95%CI(-24.03,114.25),P=0.20],increase peak oxygen-consumption[WMD=1.50,95%CI(-1.54,4.53),P=0.33],imporve NYHA classes[RR=1.71,95%CI(0.84,3.48),P=0.14],there's no singnificant differences.MRA can't reduce admission for heart failure [RR=1.33,95%CI(0.72,2.44),P=0.36]or all-cause hospitalization [RR=1.26,95%CI(0.88,1.81),P=0.21].(4)Safety of mineralocorticoid receptor antagonists:MRA can dramatically promote deterioration of renal function [RR=1.92,95%CI(1.41,2.61),P<0.0001],increase gynecomastia [RR=7.59,95%CI(1.75,32.97),P=0.007].MRA will be associated with increased rates of hyperkalemia [RR=2.58,95%CI(0.83,8.07),P=0.10],but there's no difference.Conclusion: Mineralocorticoid receptor antagonists can effectively improve cardiac diastolic function in patients of heart failure with preserved ejection fraction,improve their qualities of life but can't decrease the levels of BNP ?improve 6MWD or NYHA classes.MRA will be safe if monitoring renal function and electrolyte frequently.The long-term prognosis of mineralocorticoid receptor antagonists inpatients with HFPEF remains to be further studied due to the short follow-up time and poor sample size of this meta-analysis. |
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