Preprint Review Version 1 This version not peer reviewed

In Chronic Cardiac Decompensation with Reduced Left Ventricular Ejection Fraction, Phosphodiesterase-5 Inhibition Exerts Significant Effects on some Clinical, Functional and Hemodynamic Outcomes: a Meta-Analysis

Version 1 : Received: 22 March 2017 / Approved: 22 March 2017 / Online: 22 March 2017 (18:12:47 CET)

How to cite: De Vecchis, R.; Ariano, C. In Chronic Cardiac Decompensation with Reduced Left Ventricular Ejection Fraction, Phosphodiesterase-5 Inhibition Exerts Significant Effects on some Clinical, Functional and Hemodynamic Outcomes: a Meta-Analysis. Preprints 2017, 2017030177 (doi: 10.20944/preprints201703.0177.v1). De Vecchis, R.; Ariano, C. In Chronic Cardiac Decompensation with Reduced Left Ventricular Ejection Fraction, Phosphodiesterase-5 Inhibition Exerts Significant Effects on some Clinical, Functional and Hemodynamic Outcomes: a Meta-Analysis. Preprints 2017, 2017030177 (doi: 10.20944/preprints201703.0177.v1).

Abstract

Background: In  patients with pulmonary arterial  hypertension, substantial  clinical benefits have been reported with the use of phosphodiesterase-5 inhibitors(PDE5i) . Moreover, some studies would have proven  useful effects  of PDE5i  also  on   the clinical picture of the  pulmonary hypertension(PH) secondary to left-sided chronic heart failure(CHF). Methods: We performed a meta-analysis comprising randomized controlled trials ( RCTs) which had compared  PDE5i ( mostly sildenafil) with  placebo in CHF patients. Results: 14 studies, including 928  patients overall , were admitted to the  meta-analysis. In   heart failure with reduced left ventricular ejection fraction(HFREF), PDE5i,  compared to placebo, significantly improved the composite of death and hospitalization (OR= 0.28; 95% CI: 0.10 to 0.74). They also improved peak VO2  (difference in means[MD]: 3.76; 95% CI: 3.27 to 4.25), six-minutes walk distance ( (6MWD)(  MD, 22.7 meters ; 95% CI, 8.19 to 37.21) and pulmonary arterial systolic pressure (MD: -11.52 mmHg; 95% CI: -15.56 to -7.49). Conversely, in   CHF with preserved left ventricular ejection fraction ( HFpEF), PDE5i  were shown  not to yield  any  beneficial effect  concerning  the investigated endpoints. Conclusions: In HFREF, PDE5i  were shown  to improve  the composite of death and hospitalization, as well as    exercise capacity and pulmonary hemodynamics. Conversely,  in HFpEF, no significant clinical, ergospirometric or hemodynamic  betterment  was achieved  using PDE5i treatment.

Subject Areas

sildenafil ; phosphodiesterase-5 inhibitors; chronic heart failure; meta-analysis

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