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首页> 外文期刊>Journal of Clinical Medicine Research >Phosphodiesterase-5 Inhibitors Improve Clinical Outcomes, Exercise Capacity and Pulmonary Hemodynamics in Patients With Heart Failure With Reduced Left Ventricular Ejection Fraction: A Meta-Analysis
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Phosphodiesterase-5 Inhibitors Improve Clinical Outcomes, Exercise Capacity and Pulmonary Hemodynamics in Patients With Heart Failure With Reduced Left Ventricular Ejection Fraction: A Meta-Analysis

机译：磷酸二酯酶5抑制剂改善左心室射血分数降低的心力衰竭患者的临床疗效，运动能力和肺血流动力学：一项荟萃分析

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Background: Several studies have compared the use of phosphodiesterase-5 (PDE5) inhibitors sildenafil or udenafil with the placebo in patients suffering from pulmonary hypertension (PH) due to left chronic heart failure (CHF), corresponding to group 2 (PH due to left heart disease) of the PH classification (according to 2015 ESC/ERS guidelines for the diagnosis and treatment of PH). The results of the use of PDE5 inhibitors in the PH due to left heart disease were inconsistent and heterogeneous. Therefore, we carried out a meta-analysis to assess the effect of PDE5 inhibitors in this clinical setting, i.e., patients with left CHF.Methods: A systematic search was conducted using the PubMed and Embase electronic archives. Studies had to be prospective randomized controlled trials (RCTs). In each of the RCTs admitted to meta-analysis, a comparison was made between a group of CHF patients taking a PDE5 inhibitor and a second group assigned a placebo. Studies were incorporated in the meta-analysis provided that they had sufficient information about two or more of the following clinical, ergospirometric or hemodynamic outcomes: the composite of all-cause death and hospitalization, adverse events, peak VO2, 6-min walking distance (6MWD), left ventricular ejection fraction (LVEF), E/e’ ratio, mean pulmonary arterial pressure (mPAP), pulmonary arterial systolic pressure (PASP), and pulmonary vascular resistance (PVR).Results: Fourteen studies enrolling a total of 928 patients were incorporated in the meta-analysis. Among them,13 were RCTs and one was a subgroup analysis. Among patients with CHF with reduced left ventricular ejection fraction (HFREF, n = 555), a significant benefit was conferred by PDE5 inhibitors against the risk of the composite endpoint of death and hospitalizations (odds ratio (OR): 0.28; 95% confidence interval (CI): 0.10 - 0.74; P = 0.03). Furthermore, among HFREF patients, PDE5 inhibitors were associated with a significant improvement in peak VO2 (difference in means (MD): 3.76 mL/min/kg; 95% CI: 3.27 - 4.25) as well as in 6MWD (MD: 22.7 m; 95% CI: 8.19 - 37.21) and LVEF (MD: 4.30%; 95% CI: 2.18% to 6.42%). For patients with HFREF, PDE5 inhibitors caused a non-significant reduction in mPAP, while PASP was significantly reduced (MD: -11.52 mm Hg; 95% CI: -15.56 to -7.49; P < 0.001). By contrast, in the RCTs of patients with CHF with preserved left ventricular ejection fraction (HFpEF, n = 373), no benefit ensued from PDE5 inhibitor use regarding all of the investigated clinical, ergospirometric or hemodynamic endpoints.Conclusions: PDE5 inhibitors improved clinical outcomes, exercise capacity and pulmonary hemodynamics in patients with HFREF, but not in HFpEF. However, considering the relatively small size of the HFpEF subset enrolled so far in the RCTs that explored the PDE5 inhibitor effects, further research in this field is undoubtedly warranted.J Clin Med Res. 2017;9(6):488-498doi: https://doi.org/10.14740/jocmr3008w
机译：背景：几项研究已经比较了磷酸二酯酶5（PDE5）抑制剂西地那非或乌地那非与安慰剂在因左慢性心力衰竭（CHF）所致肺动脉高压（PH）的患者中的使用，对应于第2组（因左心脏病）的PH分类（根据2015年ESC / ERS诊断和治疗PH的指南）。由于左心疾病在PH中使用PDE5抑制剂的结果不一致且不统一。因此，我们进行了荟萃分析以评估PDE5抑制剂在此临床环境中（即左CHF患者）的作用。方法：使用PubMed和Embase电子档案进行系统搜索。研究必须是前瞻性随机对照试验（RCT）。在接受荟萃分析的每个RCT中，均对一组接受PDE5抑制剂的CHF患者与另一组分配了安慰剂的CHF患者进行了比较。该研究已纳入荟萃分析，条件是他们具有以下两种或多种临床，人体工程学或血液动力学结果的充分信息：全因死亡和住院，不良事件，VO2峰值，6分钟步行距离（ 6MWD），左心室射血分数（LVEF），E / e'比，平均肺动脉压（mPAP），肺动脉收缩压（PASP）和肺血管阻力（PVR）。结果：14项研究共纳入928项患者纳入荟萃分析。其中，有13个是RCT，一个是亚组分析。在左室射血分数降低的CHF患者中（HFREF，n = 555），PDE5抑制剂对死亡和住院的复合终点风险具有显着益处（优势比（OR）：0.28; 95％置信区间） （CI）：0.10-0.74; P ＝ 0.03）。此外，在HFREF患者中，PDE5抑制剂与峰值VO2显着改善（均数（MD）：3.76 mL / min / kg; 95％CI：3.27-4.25）以及6MWD（MD：22.7 m）相关。 ; 95％CI：8.19-37.21）和LVEF（MD：4.30％; 95％CI：2.18％至6.42％）。对于HFREF患者，PDE5抑制剂引起mPAP无明显降低，而PASP显着降低（MD：-11.52 mm Hg; 95％CI：-15.56至-7.49; P <0.001）。相比之下，在保留左心室射血分数（HFpEF，n = 373）的CHF患者的RCT中，使用PDE5抑制剂对所有研究的临床，人体工程学或血液动力学终点均无益处。结论：PDE5抑制剂改善了临床结局HFREF患者的运动能力和肺血流动力学，但HFpEF则不然。但是，考虑到迄今为止在探索PDE5抑制剂作用的RCT中纳入的HFpEF子集相对较小，因此毫无疑问需要对该领域进行进一步的研究。 2017; 9（6）：488-498doi：https://doi.org/10.14740/jocmr3008w

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