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Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials

BACKGROUND: Previous studies suggested that phosphodiesterase 5 inhibitors (PDE5i) have a beneficial effect in patients with heart failure (HF), although the results were inconsistent. We performed a meta-analysis to evaluate the effect of PDE5i in HF patients, and investigated the relationship betw...

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Autores principales: Hwang, In-Chang, Kim, Yong-Jin, Park, Jun-Bean, Yoon, Yeonyee E., Lee, Seung-Pyo, Kim, Hyung-Kwan, Cho, Goo-Yeong, Sohn, Dae-Won
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468951/
https://www.ncbi.nlm.nih.gov/pubmed/28606099
http://dx.doi.org/10.1186/s12872-017-0576-4
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author Hwang, In-Chang
Kim, Yong-Jin
Park, Jun-Bean
Yoon, Yeonyee E.
Lee, Seung-Pyo
Kim, Hyung-Kwan
Cho, Goo-Yeong
Sohn, Dae-Won
author_facet Hwang, In-Chang
Kim, Yong-Jin
Park, Jun-Bean
Yoon, Yeonyee E.
Lee, Seung-Pyo
Kim, Hyung-Kwan
Cho, Goo-Yeong
Sohn, Dae-Won
author_sort Hwang, In-Chang
collection PubMed
description BACKGROUND: Previous studies suggested that phosphodiesterase 5 inhibitors (PDE5i) have a beneficial effect in patients with heart failure (HF), although the results were inconsistent. We performed a meta-analysis to evaluate the effect of PDE5i in HF patients, and investigated the relationship between PDE5i effects and pulmonary hemodynamics. METHOD: We searched PubMed, EMBASE and the Cochrane Library for randomized controlled trials (RCTs) that compared PDE5i with placebo in HF with reduced ejection fraction (HFrEF) or HF with preserved EF (HFpEF). PDE5i effects were interpolated according to baseline pulmonary arterial pressure (PAP) or according to changes in PAP after PDE5i treatment. RESULTS: Thirteen RCTs enrolling 898 HF patients, and two sub-analysis studies with different study outcomes, were included in the meta-analysis. Among patients with HFrEF, PDE5i improved peak VO(2) (mean difference [MD], 3.76 mL/min/kg; 95% confidence interval [CI], 3.27 to 4.25; P < 0.00001), VE/VCO(2) slope (MD, −6.04; 95% CI, −7.45 to −4.64; P < 0.00001), LVEF (MD, 4.30%; 95% CI, 2.18 to 6.42; P < 0.0001), and pulmonary vascular resistance (MD, −80.74 dyn·sec/cm(5); 95% CI, −110.69 to −50.79; P < 0.00001). The effects of PDE5i in patients with HFpEF were heterogeneous. Meta-regression analyses indicated that the beneficial effect of PDE5i was related to the baseline PAP as well as the extent of PDE5i-mediated PAP decrease. CONCLUSION: PDE5i improved pulmonary hemodynamics and exercise capacity in patients with HFrEF, but not in HFpEF. The relationship between the benefits by PDE5i with the baseline PAP and the changes in PAP indicates the therapeutic potential of PDE5i in HF according to pulmonary hemodynamics. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-017-0576-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-54689512017-06-14 Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials Hwang, In-Chang Kim, Yong-Jin Park, Jun-Bean Yoon, Yeonyee E. Lee, Seung-Pyo Kim, Hyung-Kwan Cho, Goo-Yeong Sohn, Dae-Won BMC Cardiovasc Disord Research Article BACKGROUND: Previous studies suggested that phosphodiesterase 5 inhibitors (PDE5i) have a beneficial effect in patients with heart failure (HF), although the results were inconsistent. We performed a meta-analysis to evaluate the effect of PDE5i in HF patients, and investigated the relationship between PDE5i effects and pulmonary hemodynamics. METHOD: We searched PubMed, EMBASE and the Cochrane Library for randomized controlled trials (RCTs) that compared PDE5i with placebo in HF with reduced ejection fraction (HFrEF) or HF with preserved EF (HFpEF). PDE5i effects were interpolated according to baseline pulmonary arterial pressure (PAP) or according to changes in PAP after PDE5i treatment. RESULTS: Thirteen RCTs enrolling 898 HF patients, and two sub-analysis studies with different study outcomes, were included in the meta-analysis. Among patients with HFrEF, PDE5i improved peak VO(2) (mean difference [MD], 3.76 mL/min/kg; 95% confidence interval [CI], 3.27 to 4.25; P < 0.00001), VE/VCO(2) slope (MD, −6.04; 95% CI, −7.45 to −4.64; P < 0.00001), LVEF (MD, 4.30%; 95% CI, 2.18 to 6.42; P < 0.0001), and pulmonary vascular resistance (MD, −80.74 dyn·sec/cm(5); 95% CI, −110.69 to −50.79; P < 0.00001). The effects of PDE5i in patients with HFpEF were heterogeneous. Meta-regression analyses indicated that the beneficial effect of PDE5i was related to the baseline PAP as well as the extent of PDE5i-mediated PAP decrease. CONCLUSION: PDE5i improved pulmonary hemodynamics and exercise capacity in patients with HFrEF, but not in HFpEF. The relationship between the benefits by PDE5i with the baseline PAP and the changes in PAP indicates the therapeutic potential of PDE5i in HF according to pulmonary hemodynamics. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-017-0576-4) contains supplementary material, which is available to authorized users. BioMed Central 2017-06-12 /pmc/articles/PMC5468951/ /pubmed/28606099 http://dx.doi.org/10.1186/s12872-017-0576-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hwang, In-Chang
Kim, Yong-Jin
Park, Jun-Bean
Yoon, Yeonyee E.
Lee, Seung-Pyo
Kim, Hyung-Kwan
Cho, Goo-Yeong
Sohn, Dae-Won
Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials
title Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials
title_full Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials
title_fullStr Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials
title_full_unstemmed Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials
title_short Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials
title_sort pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468951/
https://www.ncbi.nlm.nih.gov/pubmed/28606099
http://dx.doi.org/10.1186/s12872-017-0576-4
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