急性失代偿性心力衰竭(ADHF)预后差,治疗选择有限。在ADHF中正在评估的合成利钠肽ularitide与其他血管活性物质之间没有直接比较。这项荟萃分析的目的是确定ADHF随机双盲试验的血流动力学效应大小。
符合条件的研究纳入了需要住院治疗和血流动力学监测的ADHF患者。患者接受了24-48小时的血管活性物质或比较剂输注。主要结果指标是肺动脉楔压(PAWP)。使用研究药物和比较药物之间的平均差异将治疗效果量化为从基线的变化。使用随机效应(主要分析)和固定效应荟萃分析对结果进行分析。十二个随机,通过治疗3,6和24小时后的数据确定了双盲研究(分别为n=622,644和644).在6小时,观察到ularitide对PAWP的显著益处优于安慰剂(对冲效应大小,-0.979;P<0.0001)。在荟萃分析中,乌立肽与其他药物的治疗差异有统计学意义(-0.501;P=0.0303).在3和24h时,ularitide的效应大小在数值上高于其他处理。6h后,观察到乌立肽和所有其他治疗方法之间的效应大小存在显著差异,用于右心房压(Hedges\'g,乌立肽为-0.797,其他治疗为-0.304;P=0.0274)。
6小时后,ularitide对PAWP和右心房压力显示出高效应大小。ularitide对这些参数的改善更大。其他血管活性药物的汇总数据。
Acute decompensated heart failure (ADHF) has a poor prognosis and limited treatment options. No direct comparisons between
ularitide-a synthetic natriuretic peptide being evaluated in ADHF-and other vasoactive substances are available. The aim of this meta-analysis was to determine haemodynamic effect sizes from randomized double-blind trials in ADHF.
Eligible studies enrolled patients with ADHF requiring hospitalization and haemodynamic monitoring. Patients received 24-48 h of infusion with a vasoactive substance or comparator. Primary outcome measure was pulmonary artery wedge pressure (PAWP). Treatment effects were quantified as changes from baseline using mean differences between study drug and comparator. Results were analysed using random-effects (primary analysis) and fixed-effects meta-analyses. Twelve randomized, double-blind studies were identified with data after 3, 6, and 24 h of treatment (n = 622, 644, and 644, respectively). At 6 h, significant PAWP benefits for
ularitide over placebo were seen (Hedges\' g effect size, -0.979; P < 0.0001). On meta-analysis, treatment difference between ularitide and pooled other agents was statistically significant (-0.501; P = 0.0303). Effect sizes were numerically higher with
ularitide than other treatments at 3 and 24 h. After 6 h, a significant difference in effect size between ularitide and all other treatments was observed for right atrial pressure (Hedges\' g, -0.797 for ularitide and -0.304 for other treatments; P = 0.0274).
After 6 h,
ularitide demonstrated high effect sizes for PAWP and right atrial pressure. Improvements in these parameters were greater with
ularitide vs. pooled data for other vasoactive drugs.