Lv Feng, Zhang Junyi, Tao Yuan
Department of Cardiology, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou City, Zhejiang Province, China.
Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou City, Jiangsu Province, China.
Front Cardiovasc Med. 2023 Feb 2;10:1054666. doi: 10.3389/fcvm.2023.1054666. eCollection 2023.
Approximately half of patients with heart failure have a preserved ejection fraction (HFpEF). To date, only SGLT-2i, ARNi, and MRAs treatments have been shown to be effective for HFpEF. Exercise intolerance is the primary clinical feature of HFpEF. The aim of this meta-analysis was to explore the effect of inorganic nitrate/nitrite supplementary therapy on the exercise capacity of HFpEF patients.
We searched PubMed, Embase, Cochrane Library, OVID, and Web of Science for eligible studies for this meta-analysis. The primary outcomes were peak oxygen consumption (peak VO), exercise time, and respiratory exchange ratio (RER) during exercise. The secondary outcomes were cardiac output, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and systemic vascular resistance during rest and exercise, respectively.
A total of eight randomized-controlled trials were enrolled for this meta-analysis. We found no benefit of inorganic nitrate/nitrite on exercise capacity in patients with HFpEF. Inorganic nitrate/nitrite compared to placebo, did not significantly increased peak VO (MD = 0.361, 95% CI = -0.17 to 0.89, = 0.183), exercise time (MD = 9.74, 95% CI = -46.47 to 65.95, = 0.734), and respiratory exchange ratio during exercise (MD = -0.003, 95% CI = -0.036 to 0.029, = 0.834). Among the six diameters reflecting cardiac and artery hemodynamics, inorganic nitrate/nitrite can lower rest SBP, rest/exercise DBP, rest/exercise MAP, and exercise SVR, but has no effect in cardiac output and heart rate for HFpEF patients.
Our meta-analysis suggested that inorganic nitrate/nitrite supplementary therapy has no benefit in improving the exercise capacity of patients with HFpEF, but can yield a blood pressure lowering effect, especially during exercise.
约半数心力衰竭患者射血分数保留（HFpEF）。迄今为止，仅钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）、血管紧张素受体脑啡肽酶抑制剂（ARNi）和醛固酮受体拮抗剂（MRAs）治疗已被证明对HFpEF有效。运动不耐受是HFpEF的主要临床特征。本荟萃分析的目的是探讨无机硝酸盐/亚硝酸盐补充疗法对HFpEF患者运动能力的影响。
我们检索了PubMed、Embase、Cochrane图书馆、OVID和科学网，以获取本荟萃分析的合格研究。主要结局是运动期间的峰值耗氧量（peak VO₂）、运动时间和呼吸交换率（RER）。次要结局分别是静息和运动期间的心输出量、心率、收缩压、舒张压、平均动脉压和全身血管阻力。
本荟萃分析共纳入8项随机对照试验。我们发现无机硝酸盐/亚硝酸盐对HFpEF患者的运动能力没有益处。与安慰剂相比，无机硝酸盐/亚硝酸盐并未显著增加peak VO₂（MD = 0.361，95%CI = -0.17至0.89，P = 0.183）、运动时间（MD = 9.74，95%CI = -46.47至65.95，P = 0.734）以及运动期间的呼吸交换率（MD = -0.003，95%CI = -0.036至0.029，P = 0.834）。在反映心脏和动脉血流动力学的六个指标中，无机硝酸盐/亚硝酸盐可降低HFpEF患者的静息收缩压、静息/运动舒张压、静息/运动平均动脉压以及运动全身血管阻力，但对心输出量和心率无影响。
我们的荟萃分析表明，无机硝酸盐/亚硝酸盐补充疗法对改善HFpEF患者的运动能力没有益处，但可产生降压作用，尤其是在运动期间。
