Chen Zhu, Zhao Kaixuan, Xiao Changhu, He Ziyu, Liu Sha, Wu Xuemei, Shi Shuting, Guo Yuan
Department of Cardiovascular Medicine, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan, China.
Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou 412007, Hunan, China.
Saudi Pharm J. 2022 Aug;30(8):1079-1087. doi: 10.1016/j.jsps.2022.05.012. Epub 2022 Jun 1.
Although heart failure with preserved ejection fraction (HFpEF) is a serious disease, only limited options are available for its treatment. Recent studies have analyzed the effects of phosphodiesterase (PDE) inhibitors, especially PDE5 and PDE3 inhibitors, in patients with HFpEF, with mixed outcomes.
We searched PUBMED and EMBASE databases up to August 2021. Randomized controlled trials (RCTs) and clinical trials that tested the effects of PDE inhibitors on patients with HFpEF were included as eligible studies. Indicators of left ventricular (LV) function, pulmonary arterial pressure (PAP), right ventricular (RV) function, exercise capacity, and quality of life (QOL) were used to evaluate the efficacy of PDE inhibitors in HFpEF.
Six RCTs that reported in 7 studies were included to evaluate the efficiency of PDE inhibitors on HFpEF patients. In the pooled analysis, PDE inhibitors showed insignificant changes in the ratio of early diastolic mitral inflow to annular velocities, left atrial volume index, pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR), peak oxygen uptake, 6-minute walking test distance, as well as Kansas City Cardiomyopathy Questionnaire score. However, substantial improvement was observed in the tricuspid annular plane systolic excursion (TAPSE). Additionally, the regression analysis showed that PDE inhibitor administration time is a critical factor for the decrease in PASP.
PDE inhibitors did not effectively improve LV function, PAP, exercise capacity, and QOL in patients with HFpEF. However, they improved RV function with significant difference, suggesting that PDE inhibitors might be a promising option for HFpEF patients with RV dysfunction.
尽管射血分数保留的心力衰竭（HFpEF）是一种严重疾病，但其治疗选择有限。最近的研究分析了磷酸二酯酶（PDE）抑制剂，尤其是PDE5和PDE3抑制剂，在HFpEF患者中的作用，结果不一。
我们检索了截至2021年8月的PUBMED和EMBASE数据库。将测试PDE抑制剂对HFpEF患者作用的随机对照试验（RCT）和临床试验纳入合格研究。使用左心室（LV）功能、肺动脉压（PAP）、右心室（RV）功能、运动能力和生活质量（QOL）指标来评估PDE抑制剂在HFpEF中的疗效。
纳入了7项研究中报告的6项RCT，以评估PDE抑制剂对HFpEF患者的疗效。在汇总分析中，PDE抑制剂在舒张早期二尖瓣流入速度与环速度之比、左心房容积指数、肺动脉收缩压（PASP）、肺血管阻力（PVR）、峰值摄氧量、6分钟步行试验距离以及堪萨斯城心肌病问卷评分方面显示出无显著变化。然而，三尖瓣环平面收缩期位移（TAPSE）有显著改善。此外，回归分析表明，PDE抑制剂给药时间是PASP降低的关键因素。
PDE抑制剂未能有效改善HFpEF患者的LV功能、PAP、运动能力和QOL。然而，它们显著改善了RV功能，表明PDE抑制剂可能是RV功能障碍的HFpEF患者的一个有前景的选择。
