Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; the First Affiliated Hospital, Southern University of Science and Technology), Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen Key Medical Discipline (SZXK003), Shenzhen, 518020, People's Republic of China.
Institution of Shenzhen Hospital, Guangzhou University of Chinese Medicine (Futian), Shenzhen, 518000, People's Republic of China.
Cardiovasc Diabetol. 2022 Nov 8;21(1):237. doi: 10.1186/s12933-022-01679-2.
Optimal treatment strategies for patients with heart failure with preserved ejection fraction (HFpEF) remain uncertain. The goal of this study was to compare the treatment effects of different therapeutic agents for patients with HFpEF.
Randomized controlled trials (RCTs) published before June 2022 were searched from PubMed, Clinical Trials gov, and the Cochrane Central Register databases. Combined odds ratios (ORs) with 95% confidence intervals (CI) were calculated for the primary and secondary outcomes. All-cause death was the primary endpoint and cardiac death, hospitalization for HF, and worsening HF (WHF) events were secondary endpoints in this meta-analysis.
Fifteen RCTs including 31,608 patients were included in this meta-analysis. All-cause and cardiac death were not significantly correlated between drug treatments and placebo. Compared with placebo, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor neprilysin inhibitors (ARNIs), and sodium-glucose cotransporter-2 (SGLT2) inhibitors significantly reduced HF hospitalizations [odds ratio (OR) = 0.64, (95% confidence interval (95%CI 0.43 - 0.96), OR = 0.73, (95%CI 0.61 - 0.86), and OR = 0.74, (95%CI 0.66 - 0.83), respectively] without heterogeneity among studies. Only SGLT2 inhibitors significantly reduced WHF events [OR = 0.75, (95%CI 0.67 - 0.83)].
No treatments were effective in reducing mortality, but ARNIs, ACEIs or SGLT2 inhibitors reduced HF hospitalizations and only SGLT2 inhibitors reduced WHF events for patients with HFpEF.
对于射血分数保留的心力衰竭（HFpEF）患者，最佳治疗策略仍不确定。本研究的目的是比较不同治疗药物对 HFpEF 患者的治疗效果。
从 PubMed、ClinicalTrials.gov 和 Cochrane 中央注册数据库中检索 2022 年 6 月前发表的随机对照试验（RCT）。主要和次要结局的合并比值比（OR）及其 95%置信区间（CI）。全因死亡是该meta 分析的主要终点，心脏死亡、HF 住院和 HF 恶化（WHF）事件是次要终点。
该 meta 分析共纳入 15 项 RCT，共 31608 例患者。药物治疗与安慰剂之间的全因死亡和心脏死亡无显著相关性。与安慰剂相比，血管紧张素转换酶抑制剂（ACEIs）、血管紧张素受体脑啡肽酶抑制剂（ARNI）和钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂可显著减少 HF 住院[OR=0.64（95%CI 0.43-0.96）、OR=0.73（95%CI 0.61-0.86）和 OR=0.74（95%CI 0.66-0.83）]，且研究间无异质性。只有 SGLT2 抑制剂可显著减少 WHF 事件[OR=0.75（95%CI 0.67-0.83）]。
没有治疗方法能有效降低死亡率，但 ARNI、ACEI 或 SGLT2 抑制剂可减少 HF 住院，只有 SGLT2 抑制剂可减少 HFpEF 患者的 WHF 事件。
