射血分数保留的心力衰竭(HFpEF)是一种普遍且具有临床意义的疾病,其特征是治疗选择有限。在这种情况下,本荟萃分析的目的是评估沙库巴曲/缬沙坦与血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)相比在治疗HFpEF方面的有效性.
■在PubMed,Embase,WebofScience,科克伦图书馆纳入HFpEF患者沙库必曲/缬沙坦与ACEI或ARB的随机对照试验。纳入标准:LVEF>45%,NYHAII-IV,Sac/ValvsACEI/ARB,RCT,治疗持续时间>3个月,每组样本量≥25。排除标准:动物研究,数据不清楚/缺失,质量差,案例研究/专家意见。心力衰竭住院和心血管死亡率是主要结果,而额外的结果包括所有原因的死亡率,NYHA类的改进,NT-proBNP的修饰,和LVEF。
■与ACEI和ARB相比,沙库必曲/缬沙坦大大降低了心力衰竭的住院率,根据总共六项涉及5201名参与者的研究(相对风险,0.78;95%CI,0.65至0.85;P=.001)。尽管如此,心血管疾病导致的死亡率没有显著改善(相对风险,0.94;95%CI,0.79-1.12;P=.563)。沙库必曲/缬沙坦对所有原因的总死亡率没有显著影响(相对风险,0.95;95%CI,0.84-1.09;P=.453),但它确实提高了NYHA分类(相对风险,1.25;95%CI,1.10-1.43;P=.001)。NT-proBNP水平大幅下降(加权平均差,-266.67;95%CI,-525.86至-7.47),而LVEF(加权平均差,1.49;95%CI,-1.33至4.21;P=.342)。
■沙库必曲/缬沙坦可能在降低心力衰竭住院率方面提供优越的益处,NT-proBNP水平,与ACEI和ARBs相比,HFpEF患者的NYHA分类有所改善。由于Sacubitril/缬沙坦可降低心力衰竭住院率和改善症状严重程度,因此可将其视为HFpEF患者的首选治疗选择。
UNASSIGNED: Heart failure with preserved ejection fraction (HFpEF) is a prevalent and clinically significant condition characterized by limited treatment options. In this context, the objective of this meta-analysis is to evaluate the effectiveness of sacubitril/
valsartan compared to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in managing HFpEF.
UNASSIGNED: A systematic search of relevant studies was conducted in PubMed, Embase, Web of Science, and Cochrane Library. Randomized controlled trials comparing sacubitril/
valsartan to ACEIs or ARBs in HFpEF patients were included. Inclusion criteria: LVEF>45%, NYHA II-IV, Sac/Val vs ACEI/ARB, RCTs, treatment duration >3 months, sample size ≥25 per group. Exclusion criteria: Animal studies, unclear/missing data, poor quality, case studies/expert opinions.Hospitalization for heart failure and cardiovascular mortality were the primary outcomes, while the additional results included mortality from all causes, improvement of NYHA class, modifications in NT-proBNP, and with LVEF.
UNASSIGNED: Sacubitril/
valsartan substantially reduced heart failure hospitalization rates compared to ACEIs and ARBs, according to a total of six studies involving 5,201 participants (Relative Risk, 0.78; 95% CI, 0.65 to 0.85; P = .001). Nonetheless, there were no significant improvements in mortality due to cardiovascular disease (Relative Risk, 0.94; 95% CI, 0.79-1.12; P = .563). Sacubitril/
valsartan did not affect total mortality from all causes significantly (Relative Risk, 0.95; 95% CI, 0.84-1.09; P = .453), but it did enhance NYHA classification (Relative Risk, 1.25; 95% CI, 1.10-1.43; P = .001). NT-proBNP levels decreased substantially (Weighted Mean Difference, -266.67; 95% CI, -525.86 to -7.47), whereas there had been little major shift in LVEF (Weighted Mean Difference, 1.49; 95% CI, -1.33 to 4.21; P = .342).
UNASSIGNED: Sacubitril/valsartan may provide superior benefits in reducing heart failure hospitalization rates, NT-proBNP levels, and improving NYHA classification in patients with HFpEF compared to ACEIs and ARBs. Sacubitril/
valsartan might be considered as a preferred treatment option for HFpEF patients due to its benefits in reducing heart failure hospitalization rates and improving symptom severity.