Department of Cardiology, Shanghai Cardiovascular Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Int J Cardiol. 2012 Feb 23;155(1):33-8. doi: 10.1016/j.ijcard.2011.01.081. Epub 2011 Apr 11.
The effect of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction remains controversial.
To assess the impact of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction.
Seven prospective studies evaluating the effect of ACE inhibitors compared to placebo or other classes of drugs, such as monotherapy or first-line therapy, on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction were included. A total of 2554 patients (mean age: 75.1 years, female: 58%) were recruited with an average follow up of 20.9 months. The primary etiology of heart failure with preserved ejection fraction was ischemic heart disease (33.7%), hypertension (69.1%) and diabetes mellitus (25.8%). Our results demonstrated that ACE inhibitors significantly reduced all-cause mortality (odds ratio, OR = 0.52; 95% Confidence Interval (CI), 0.41 to 0.64; P<0.01). Furthermore, ACE inhibitors were able to reduce heart failure related rehospitalization or treatment over 20.9 months (p<0.05) in a subgroup of patients aged over 75 years. However, death due to worsening of heart failure, heart failure related rehospitalization and any-cause readmission were not affected (OR = 0.88; 95% CI: 0.66 to 1.17; P = 0.37 for death due to worsening of heart failure; OR = 0.81; 95% CI: 0.63 to 1.05; P = 0.11 for heart failure related rehospitalization and OR = 0.88; 95% CI: 0.68 to 1.14; P = 0.33 for any-cause readmission, respectively).
In patients with chronic heart failure with preserved ejection fraction, ACE inhibitors reduced all-cause mortality without affecting mortality due to heart failure and any-cause rehospitalization.
血管紧张素转换酶抑制剂（ACEI）对射血分数保留的慢性心力衰竭（HFpEF）患者预后的影响仍存在争议。
评估 ACEI 对射血分数保留的慢性心力衰竭患者预后的影响。
纳入了 7 项前瞻性研究，这些研究评估了 ACEI 与安慰剂或其他类别的药物（如单药或一线治疗）相比，对射血分数保留的慢性心力衰竭患者预后的影响。共纳入 2554 例患者（平均年龄：75.1 岁，女性：58%），平均随访 20.9 个月。射血分数保留的心衰的主要病因是缺血性心脏病（33.7%）、高血压（69.1%）和糖尿病（25.8%）。我们的研究结果表明，ACEI 可显著降低全因死亡率（比值比，OR = 0.52；95%置信区间，0.41 至 0.64；P<0.01）。此外，ACEI 能够降低 20.9 个月内心力衰竭相关再住院或治疗（p<0.05）的风险，在年龄超过 75 岁的亚组患者中。然而，因心力衰竭恶化导致的死亡、心力衰竭相关再住院和任何原因再入院均不受影响（OR = 0.88；95%置信区间：0.66 至 1.17；P = 0.37 用于心力衰竭恶化导致的死亡；OR = 0.81；95%置信区间：0.63 至 1.05；P = 0.11 用于心力衰竭相关再住院；OR = 0.88；95%置信区间：0.68 至 1.14；P = 0.33 用于任何原因再入院）。
在射血分数保留的慢性心力衰竭患者中，ACEI 降低了全因死亡率，而不影响心力衰竭导致的死亡率和任何原因的再住院率。
