β受体阻滞剂和血管紧张素转换酶抑制剂在非缺血性扩张型心肌病中的疗效：一项系统评价和荟萃分析。

Efficacy of Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors in Non-Ischemic Dilated Cardiomyopathy: A Systematic Review and Meta-Analysis.

作者信息

Llerena-Velastegui Jordan, Santamaria-Lasso Melisa, Mejia-Mora Melany, Santander-Aldean Mauricio, Granda-Munoz Andrea, Hurtado-Alzate Claudia, de Jesus Ana Clara Fonseca Souza, Baldelomar-Ortiz Jurgen

机构信息

Medical School, Pontifical Catholic University of Ecuador, Quito, Ecuador.

Research Center, Center for Health Research in Latin America (CISeAL), Quito, Ecuador.

出版信息

Cardiol Res. 2024 Aug;15(4):281-297. doi: 10.14740/cr1653. Epub 2024 Jul 18.

DOI:10.14740/cr1653

PMID:39205958

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11349132/

Abstract

BACKGROUND

Non-ischemic dilated cardiomyopathy (NIDCM) is a form of heart failure with a poor prognosis and unclear optimal management. The aim of the study was to systematically review the literature and assess the efficacy and safety of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in the management of chronic heart failure secondary to NIDCM and explore their putative mechanisms of action.

METHODS

Studies from 1990 to 2023 were reviewed using PubMed and EMBASE, focusing on their effects on left ventricular ejection fraction (LVEF) in NIDCM patients, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Beta-blockers showed a significant beneficial effect on LVEF improvement in NIDCM, with an overall effect size of Cohen's = 1.30, 95% confidence interval (CI) (0.76, 1.84), high heterogeneity (Tau = 0.90; Chi = 162.05, df = 13, P < 0.00001; I = 92%), and a significant overall effect (Z = 4.72, P < 0.00001). ACE inhibitors also showed a beneficial role, but with less heterogeneity (Tau = 0.02; Chi = 1.09, df = 1, P = 0.30; I = 8%) and a nonsignificant overall effect (Z = 1.36, P = 0.17), 95% CI (-0.24, 1.31).

CONCLUSIONS

The study highlights the efficacy of carvedilol in improving LVEF in NIDCM patients over ACE inhibitors, recommends beta-blockers as first-line therapy, and advocates further research on ACE inhibitors.

摘要

背景

非缺血性扩张型心肌病（NIDCM）是一种心力衰竭形式，预后较差，最佳治疗方案尚不明确。本研究的目的是系统回顾文献，评估β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂在治疗NIDCM继发的慢性心力衰竭中的疗效和安全性，并探讨其可能的作用机制。

方法

根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed和EMBASE对1990年至2023年的研究进行回顾，重点关注其对NIDCM患者左心室射血分数（LVEF）的影响。

结果

β受体阻滞剂对改善NIDCM患者的LVEF显示出显著的有益作用，总体效应量为Cohen's d = 1.30，95%置信区间（CI）（0.76，1.84），异质性高（Tau = 0.90；Chi = 162.05，df = 13，P < 0.00001；I² = 92%），总体效应显著（Z = 4.72，P < 0.00001）。ACE抑制剂也显示出有益作用，但异质性较小（Tau = 0.02；Chi = 1.09，df = 1，P = 0.30；I² = 8%），总体效应不显著（Z = 1.36，P = 0.17），95% CI（-0.24，1.31）。