■非缺血性扩张型心肌病(NIDCM)是一种心力衰竭,预后不良,最佳治疗方法不明确。该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NIDCM继发慢性心力衰竭治疗中的疗效和安全性,并探讨其推定的作用机制。
■使用PubMed和EMBASE审查了1990年至2023年的研究,关注它们对NIDCM患者左心室射血分数(LVEF)的影响,根据系统评价和荟萃分析(PRISMA)指南的首选报告项目。
■β-受体阻滞剂对NIDCM的LVEF改善显示出明显的有益作用,总体效应大小为科恩d=1.30,95%置信区间(CI)(0.76,1.84),高异质性(Tau2=0.90;Chi2=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的作用,但异质性较小(Tau2=0.02;Chi2=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)。
■该研究强调了卡维地洛在改善NIDCM患者LVEF方面的功效,推荐β受体阻滞剂作为一线治疗,并主张进一步研究ACE抑制剂。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Beta-blockers showed a significant beneficial effect on LVEF improvement in NIDCM, with an overall effect size of Cohen\'s d = 1.30, 95% confidence interval (CI) (0.76, 1.84), high heterogeneity (Tau2 = 0.90; Chi2 = 162.05, df = 13, P < 0.00001; I2 = 92%), and a significant overall effect (Z = 4.72, P < 0.00001). ACE inhibitors also showed a beneficial role, but with less heterogeneity (Tau2 = 0.02; Chi2 = 1.09, df = 1, P = 0.30; I2 = 8%) and a nonsignificant overall effect (Z = 1.36, P = 0.17), 95% CI (-0.24, 1.31).
UNASSIGNED: 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.