Huang Pingping, Song Qingya, Wang Yifei, Wang Anzhu, Guo Lijun, Zhang Hongwei, Zhang Zhibo, Ma Xiaochang
Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Graduate School, China Academy of Chinese Medical Sciences, Beijing, China.
Front Cardiovasc Med. 2022 Dec 14;9:1071387. doi: 10.3389/fcvm.2022.1071387. eCollection 2022.
Heart failure is the end stage of all cardiovascular diseases, which brings a heavy burden to the global health network. Arotinolol, as a new type of β Receptor blocker, has a good antihypertensive effect. Many clinical trials have observed the clinical efficacy of arotinolol in the treatment of essential hypertension. However, so far, there has been no systematic evaluation on the efficacy and safety of arotinolol in the treatment of chronic heart failure.
The purpose of this review was to systematically evaluate the clinical efficacy of arotinolol in patients with chronic heart failure.
Randomized controlled trials (RCTs) of arotinolol in the treatment of chronic heart failure were retrieved from seven databases according to the Cochrane manual, including CNKI (China National Knowledge Infrastructure), Wan fang database, VIP database, PubMed, Sinomed, EMBASE, and the Cochrane Library databases. The main outcomes were the effective rate, left ventricular ejection fraction (LVEF), blood pressure, heart rate, cardiac index, stroke volume (SV), brain natriuretic peptide (BNP), hypersensitive C-reactive protein (Hs-CRP), left ventricular end diastolic volume (LVEDV), left ventricular end diastolic diameter (LVEDD), and adverse events (AEs).
A total of 17 trials met the qualification criteria, which included 1,717 patients with heart failure. Most trials had uncertain risks in terms of random sequence generation, allocation hiding, patient loss, and result evaluation. Meta analysis showed that arotinolol significantly improved the treatment efficiency of patients with heart failure (standardized mean difference (SMD) = 4.07, 95% confidence interval (CI) [2.89, 5.72], = 0.00, = 0), LVEF (SMD = 1.59, 95% CI [0.99, 2.19], = 0.000 0, = 95.8%), cardiac index (SMD = 0.32, 95% CI [0.11, 0.53], = 0.03), = 0), SV (SMD = 2.00, 95% CI [1.57, 2.34], = 0.000, = 64.2%), lower BNP (SMD = -0.804, 95% CI [-0.97, -0.64], = 0.000, = 94.4%), and LVEDV (SMD = -0.25, 95% CI [-0.45, -0.05], = 0.015, = 0). There was no statistical significance for blood pressure (SMD = -0.09, 95% CI [-0.69, 0.51], = 0.775, = 90.2%; SMD = -0.16, 95% CI [-0.79, 0.48], = 0.632, = 91.2%), heart rate (SMD = -0.12, 95% CI [-1.00, 0.75], = 0.787, = 96.1%), Hs-CRP (SMD = -1.52, 95% CI [-3.43, 0.40], = 0.121, = 98.3%), and LVEDD (SMD = -0.07, 95% CI [-0.90, 0.76], = 0.870, = 96.5%).
Arotinolol can safely and effectively improve the effective rate of patients with chronic heart failure, increase LVEF, increase CI and SV, and reduce BNP and LVEDV. However, because of the low overall quality of the included randomized controlled trials, these findings need to be considered carefully. More high-quality randomized controlled trials are needed for further verification, to provide a more scientific basis for the safety and effectiveness of arotinolol in the clinical treatment of heart failure.
[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=371214], identifier [CRD:420223371214].
心力衰竭是所有心血管疾病的终末期，给全球卫生网络带来沉重负担。阿罗洛尔作为一种新型β受体阻滞剂，具有良好的降压效果。许多临床试验观察了阿罗洛尔治疗原发性高血压的临床疗效。然而，迄今为止，尚未对阿罗洛尔治疗慢性心力衰竭的疗效和安全性进行系统评价。
本综述旨在系统评价阿罗洛尔治疗慢性心力衰竭患者的临床疗效。
根据Cochrane手册，从七个数据库检索阿罗洛尔治疗慢性心力衰竭的随机对照试验（RCT），包括中国知网（CNKI）、万方数据库、维普数据库、PubMed、中国生物医学文献数据库、EMBASE和Cochrane图书馆数据库。主要结局指标为有效率、左心室射血分数（LVEF）、血压、心率、心脏指数、每搏输出量（SV）、脑钠肽（BNP）、超敏C反应蛋白（Hs-CRP）、左心室舒张末期容积（LVEDV）、左心室舒张末期内径（LVEDD）和不良事件（AE）。
共有17项试验符合纳入标准，包括1717例心力衰竭患者。大多数试验在随机序列产生、分配隐藏、患者失访和结果评估方面存在不确定风险。Meta分析显示，阿罗洛尔显著提高心力衰竭患者的治疗有效率（标准化均数差（SMD）=4.07，95%置信区间（CI）[2.89，5.72]，P=0.00，I²=0）、LVEF（SMD=1.59，95%CI[
0.99，2.19]，P=0.000 0，I²=95.8%）、心脏指数（SMD=0.32，95%CI[0.11，0.53]，P=0.03，I²=0）、SV（SMD=2.00，95%CI[1.57，2.34]，P=0.000，I²=64.2%），降低BNP（SMD=-0.804，9
5%CI[-0.97，-0.64]，P = 0.000，I² = 94.4%）和LVEDV（SMD = -0.25，95%CI[-0.45，-0.05]，P = 0.015，I² = 0）。血压（SMD = -0.09，95%CI[-0.69，0.51]，P = 0.775，I² = 90.2%；SMD = -0.16，95%CI[-0.79，0.48]，P = 0.632，I² = 91.2%）、心率（SMD = -0.1
2，95%CI[-1.00，0.75]，P = 0.787，I² = 96.1%）、Hs-CRP（SMD = -1.52，95%CI[-3.43，0.40]，P = 0.121，I² = 98.3%）和LVEDD（SMD = -0.07，95%CI[-0.90，0.76]，P = 0.870，I² = 96.5%）差异无统计学意义。
阿罗洛尔可安全有效地提高慢性心力衰竭患者的有效率，增加LVEF、CI和SV，降低BNP和LVEDV。然而，由于纳入的随机对照试验整体质量较低，这些结果需谨慎考虑。需要更多高质量的随机对照试验进行进一步验证，为阿罗洛尔在心力衰竭临床治疗中的安全性和有效性提供更科学的依据。
[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=371214]，标识符[CRD：420223371214]
