Zaheen Mithila, Ferdous Fardin, Amarasekera Anjalee T, Petutschnigg Johannes, Edelmann Frank, Tan Timothy C
Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW 2148, Australia.
University of Sydney, Sydney, NSW 2006, Australia.
J Clin Med. 2025 May 21;14(10):3598. doi: 10.3390/jcm14103598.
: Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome with limited therapeutic options. Mineralocorticoid receptor antagonists (MRAs) have been shown to improve clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF), but their use in patients with HFpEF remains controversial. The aim of this review is to evaluate whether the use of MRAs improves diastolic function, functional capacity, and quality of life in patients with HFpEF. : A systematic literature search of scientific databases was performed to identify studies comparing the use of MRAs to placebo or no treatment in adult patients with HFpEF (2000-2024; English; PROSPERO registration CRD42022300783). Data were meta-analysed using a random-effects model for overall effect size measured as the standardised mean difference. : Pooled data revealed a significant benefit of MRA use compared to the control in decreasing E/e' (SMD -0.21; 95% CI: -0.33 to -0.10, = 0.00), with greater improvement seen with longer duration of treatment. A substantial reduction in systolic blood pressure (SMD -0.27; 95% CI: -0.53 to -0.02, = 0.03) and diastolic blood pressure (SMD -0.18; 95% CI: -0.32 to -0.04, = 0.01) was also noted. There was no significant difference in the 6 min walk distance, peak exercise capacity, or quality-of-life measures. Adverse events such as hyperkalaemia and worsening renal function were frequently reported in the MRA group. : MRAs improve echocardiographic parameters of diastolic function and BP control; however, this did not translate into clinical outcomes of improved functional capacity or quality of life.
射血分数保留的心力衰竭（HFpEF）是一种复杂的临床综合征，治疗选择有限。盐皮质激素受体拮抗剂（MRAs）已被证明可改善射血分数降低的心力衰竭（HFrEF）患者的临床结局，但其在HFpEF患者中的应用仍存在争议。本综述的目的是评估MRAs的使用是否能改善HFpEF患者的舒张功能、功能能力和生活质量。：对科学数据库进行了系统的文献检索，以确定比较MRAs与安慰剂或不治疗在成年HFpEF患者中的使用情况的研究（2000 - 2024年；英文；PROSPERO注册号CRD42022300783）。使用随机效应模型对数据进行荟萃分析，以标准化平均差衡量总体效应大小。：汇总数据显示，与对照组相比，使用MRAs在降低E/e'方面有显著益处（标准化平均差 -0.21；95%置信区间：-0.33至-0.10，P = 0.00），治疗时间越长改善越明显。还注意到收缩压（标准化平均差 -0.27；95%置信区间：-0.53至-0.02，P = 0.03）和舒张压（标准化平均差 -0.18；95%置信区间：-0.32至-0.04，P = 0.01）大幅降低。6分钟步行距离、峰值运动能力或生活质量指标方面无显著差异。MRA组经常报告高钾血症和肾功能恶化等不良事件。：MRAs可改善舒张功能的超声心动图参数和血压控制；然而，这并未转化为功能能力或生活质量改善的临床结局。
